by Thorsten Krüger, Kora Klapp & Tricia Mitchell
Abstract
This article examines the social and economic consequences of political responses to Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) within a European context. Drawing on medical perspectives, the interplay between humans and viruses are discussed, as is ways to strengthen the immune system, which is compromised by factors such as stress during prolonged periods of economic crisis. The economic impact of closing borders to destinations dependent upon tourism is illustrated in a case study on the Canary Islands. As epidemiological information is used by governments to plan and evaluate strategies to determine public health outcomes, while the epidemiology of Covid-19 is still being mapped out, this paper concludes that a measured approach to policies based on multi-disciplinary responses is required.
Are the lockdown measures science-based?
The extent of which the Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) continues to dominate and disrupt daily life in Europe is increasing. While there is much speculation about the medical aspects of the virus, less focus has been given to the foreseeable social consequences. This is despite competent scientists, such as German virologist, Professor Christian Drosten, director of the Institute for Virology at Berlin’s Charité hospital, urging politicians to base decisions on interdisciplinary scientific discussions [1]:
“Now is the time when politics absolutely needs a few days of rest to get advice. Not always from the same people, but also from other disciplines. And it is imperative that we now allow policymakers to be calm about such important decisions as school closures. It is harmful now when political journalists say that “we are doing what we always do. That is, we take a quote from this expert, play it to the public and create an urgency for politicians to address this mood that is created in the people, by making decisions”. I think, at this point it is bad for politicians to simply decide quickly and then have to course-correct because the decisions were too grave. Political journalists should now try to work a bit more like science journalists – with more background and with a little more calm.”[1]
So, let’s take the time to look at the new coronavirus from different perspectives.
The natural interplay between humans and viruses
Viruses are not a new phenomena. Viral effects on the human body have been evidenced as present at the end of the Neolithic period (i.e. the New Stone Age) [2]. To date, much of the immunity human beings have acquired can be traced back to the natural interplay between viruses and the human body.
The spreading of a new – or sufficiently modified – virus can, in principle, come to a standstill due to two effects: either when the pathogen, for whatever reasons, loses its vigour, as in the SARS pandemic 2002/03 [3], or when the number of immunized persons relevantly exceeds the number of non-immunized persons. Prof. John Ziebuhr heads the Institute of Medical Virology at the University of Giessen. He describes the process regarding SARS-CoV-2 as follows:
“At the moment, we assume that every person infected in a society without immunity, as we currently have, infects three other people, on average. The spread of the virus can only be stopped if each infected person infects less than one other person. If two-thirds of the population had contact with the virus and are therefore immune, two of the three people that each infected person would spread the virus to will already be immune. The virus will then continue to circulate, but will no longer lead to exponential new infection. At least that’s the theory.” [4]
In the same interview, Prof.Ziebuhr confirms that the virus will spread extremely widely, no matter how much we restrict our daily lives:
“The question is only in what time. Does it happen within six months, or twelve, or will it take even longer? Measures are designed to slow down the outbreak as much as possible. This makes a lot of sense so that our actually well-functioning hospital system does not collapse due to the large number of patients who need treatment in the intensive care unit. This is a real danger at the moment.” [4]
The effects of lockdown – the Canary Islands
The Canary Islands are an all year round tourist destination, with 13.2 million tourists in 2019 and a turnover of €15,071 million. [5]
Nevertheless, unemployment is problematic in Canarian society, especially among young people, as illustrated by
these figures taken from the fourth quarter of 2019 [6]:
- 54.6% unemployed persons under 20 years
- 31.9% unemployed persons between 20 and 24 years
- 17.5 % unemployed persons between 25 and 54 years
- 17.4 % unemployed persons over 54 years
Tourism is the most fundamental contributor to the Canary Islands’ economy, generating more than 40% of all jobs and 35% of the GDP. [7] In line with the Spanish government’ decree to lockdown the nation, effective as of 15 March 2020, the regional Canary government shut its borders to international air and sea travel indefinitely. The primary effect is the shutdown of the whole tourism sector.
It’s not only the big hotel chains who are affected by the shutdown. There are lots of small businesses dependent upon tourist spending which may have to close their doors now [7]:
“Tourism is, by its nature, a horizontal sector, having an impact on practically every sector of the economy, and it is capable of generating induced income in sectors such as commerce, leisure and the services in general which our visitors use, whether they come through a tour operator or independently.
[…]The collapse of Thomas Cook – the UK based tour operator with subsidiaries in other countries – back in September 2019, left many businesses within the tourism sector in a precarious financial position. More than 600 Spanish hotels were owed in excess of €260 million as a result of Thomas Cook UK’s administration, leaving companies and small business owners with a lack of short-term liquidity and “drastic worsening of the balance sheets”.
If we assume the most favourable scenario, according to Prof. Ziebuhr, the whole Canarian tourism sector would need to shut down for at least 6 months and the entire summer season would be cancelled. Given that the sector has yet to recover from unpaid debts arising from last year’s summer season and an anticipated decline in tourist numbers in the winter season, how will individuals react and cope with these latest restrictions to their livelihoods?
The impact on human lives – the overlooked factor?
Are people immune to existential concerns arising from economic crises on a national scale?
Popvici and French researched the relation between unemployment and alcohol consumption [8]:
“Our results indicate that individual unemployment is a risk factor for unhealthy behavior (i.e., alcohol misuse). Specifically, we show a positive and significant association between job loss during the past year and average daily ethanol consumption, number of binge drinking days, and the probability of an alcohol abuse and/or dependence diagnosis.”
Using the example of the economic crisis of 2008/09, the German medical journal “Ärzteblatt” summarized the findings of a significant increase in the suicide rate [9]:
“The 27 European countries were those hit hardest, with an increase of 4.2 percent and 18 American countries (up 6.4 percent). In Europe, the suicide rate increased especially among 15-24 year olds, which is likely to be related to high youth unemployment. In America, it mainly affected 45-64-year-olds.
[…]
According to Chang, the suicides are only the tip of an iceberg. For every completed suicide there would be 30 to 40 attempts, and for every attempt another ten people with suicidal thoughts. In addition, the economic crisis was far from over in 2009. According to initial estimates, the suicide rate is expected to have risen by another 10.8 percent in 2010.”
It is essential to acknowledge that chronic stress, such as a prolonged economic crisis, can take the immune system out of balance. Chronic stressors have a negative impact on almost all functional measures of the immune system. Both natural and specific immunity are negatively affected.[10] [11] [12]
The role of the immune system in Covid-19
Any virus, however dangerous, is nothing without its host cell, which it needs to multiply. With the primary intention of spreading itself, it would, of course, be counterproductive for a virus to kill its host. In any case, a virus contains foreign biological information that activates the natural control mechanisms within the human body.
The gateway for SARS-CoV-2 is the enzyme ACE2, which is expressed in many cells, such as in the heart’s muscle and vascular cells, in the kidneys, the intestines and in the lungs [13]. The main entrance for the virus, which is mainly transmitted by droplet infection, is in the air that we breathe. However, the lungs are far from sterile [14]:
It has only been known for a few years that bacteria, fungi and viruses also live in the lungs – actually in all humans. The totality of these microorganisms is called the microbiome. Scientists are still investigating the function of this lung microbiome in detail.
Reports in the media of current Covid-19 cases mainly attribute pneumonia to the new virus.
Given that the type of microbes – viral, bacterial and fungal – and volume will differ in each patient’s lung microbiome, by determining the pre-existing components that ‘may’ differentiate the individual response to Covid-19 would that provide a more accurate overview of the interactions and interconnection between the virus and its human host?
Research teams at the Charité developed a model of human lung tissue that can simulate essential characteristics of pneumonia. They first infected the tissue with influenza viruses and then with pneumococci (bacteria) to simulate severe pneumonia. Due to their structural differences, viruses and bacteria are rendered harmless by the immune system in various ways [15]:
“We have been able to demonstrate that the anti-virus immune response is harmful to the subsequent control of a bacterial infection with pneumococci.”
This research suggests that the overlay of the viral infection by Sars-CoV-2 with a bacterial infection may be the cause of the life-threatening pneumonia observed in Covid-19. So far, no information has been made public about other factors, such as influenza viruses, whose occurrence would not be uncommon this winter.
Unprotected at the mercy of the virus?
The explanation for the serious illnesses in individual cases of Covid-19 shows that we are dealing with a complex system. But the human organism would not have survived millennia of interaction with viruses if it were not able to handle advanced challenges such as these.
In the case of SARS-CoV-2, Prof. Drosten describes in his podcast of 17.3.2020 the discovery that the viruses are mainly active in the throat area in the first week of infection, before descending into the deeper airways in the second week. This gives the body’s immune system critical response time before fundamental bodily functions, such as breathing, can be impaired [16]:
“With this virus, the seroconversion happens with high reliability already at the end of the first week in these patients. This is something I was both surprised and pleased about, because this suggests that in the event of this infection, immunity very quickly sets in. And of course you can speculate a lot about why this is so and why it is so different from SARS. And there are two clues.
One is theoretical and easy to understand. If we have a virus that is already replicating in the throat before it goes into the lungs, then we actually can count the whole time that the virus is already replicating in the throat, for immunisation to develop. In other words, we say the antigen stimulus, i.e. the stimulus caused by the presence of a virus, on the immune system already goes off. And perhaps it is the case that at the moment when the virus then migrates down into the lungs at the end of the first week, these patients are already so far that they actually make an immune reaction, because there was this advance in the throat before. And this is a good situation. Maybe this protects against infection of the lungs. Thinking around the corner, this is a very interesting hypothesis.
I am deliberately not saying explanation, but I am saying a hypothesis. An idea that could explain why some patients, even though they are very young, still get a fast, difficult course. Because it is conceivable that some persons do not get infected in the throat first, but immediately inhale a high dose of virus from the air into the lungs and that the infection starts right there. In these cases it is more like with the severe SARS virus, the original SARS virus.”
So for each of us, the key to successfully coping with Covid-19 lies in our own immune system, which regulates resilience to foreign bodies and information. It does this with the help of both innate and acquired mechanisms to learn and to filter, what can be tolerated or even used, and what is recognized and combated as harmful – a fine balance. An ‘as yet unknown’ virus has the chance to enter the body and replicate there, before the body decides whether or not, it will neutralize the virus, and by what means. This is why influenza viruses actually have to mutate every year to produce flu symptoms.
Knowing this, the majority of people need not fear these symptoms. As a rule, there will be little response to exposure. And viruses are not designed to kill their host.
So how can you strengthen your immune system?
The Charité’s aforementioned studies of the lung microbiome already suggest that there are no ‘plug & play’ solutions to Covid-19. Harvard University has summarized its many years of research as this [17]:
The idea of boosting your immunity is enticing, but the ability to do so has proved elusive for several reasons. The immune system is precisely that — a system, not a single entity. To function well, it requires balance and harmony. There is still much that researchers don’t know about the intricacies and interconnectedness of the immune response. For now, there are no scientifically proven direct links between lifestyle and enhanced immune function.
But that doesn’t mean the effects of lifestyle on the immune system aren’t intriguing and shouldn’t be studied. Researchers are exploring the effects of diet, exercise, age, psychological stress, and other factors on the immune response, both in animals and in humans. In the meantime, general healthy-living strategies are a good way to start giving your immune system the upper hand.
Salutogenesis vs containment – The social factor
A study by the John Hopkins School of Medicine showed that even chronic, subclinical mild depression can suppress an elderly person’s immune system [10]:
Participants in the study were in their early 70s and caring for someone with Alzheimer’s disease. Those with chronic mild depression had weaker lymphocyte-T cell responses to two mitogens, which model how the body responds to viruses and bacteria. The immune response was decreased further still 18 months later, and immunity declined with age. In line with the 2004 meta-analysis, it appeared that the key immune factor was duration, not severity, of depression. And in the case of the older caregivers, their depression and age meant a double-whammy for immunity.
As expected, the normal aging process is weakening us. But a depressive mood over a longer period of time is the main factor for a poorly functioning immune system.<7p>
This is not only true for older people. Young people respond to a lack of social contact and support, as shown by Carnegie Mellon University’s study of students after flu shots [10]:
Small networks and loneliness each independently weakened immunity to a core vaccine component. Immune response was most weakened by the combination of loneliness and small social networks, an obvious health stress facing shy, new students who have yet to build their friendship circles.
Given the impact that unwanted social isolation and longer-term unemployment have on the immune system’s effectiveness to combat infections, these social factors need to be taken into account when considering measures to contain the corona virus pandemic.
In terms of salutogenesis, restrictions placed upon personal freedom must not only be comprehensible and accepted, but must also be conceivably temporary and thus manageable.
Also the importance of sunlight, for vitamin D production, exercise and body experience for the immune system, should be incorporated into meaningful measures.
The preservation of social distance must not degenerate into house arrest for responsible citizens, preventing all outdoor activities, and imposing a threat of fines, as is currently the case in Spain, France and Italy.
What’s the alternative?
Based on this knowledge, we can use the experience of countries with different strategies to guide our policies. In Italy, Spain and France, the authorities are resorting to restricting fundamental rights.
Sweden, Iceland and the Netherlands, on the other hand, choose transparency and less restrictive measures than other European countries. Quarantine measures are adapted as needed, while limiting social stress [18] [19].Swedish state epidemiologist Anders Tegnell warned that there was no ‘secret formula’ that could accurately predict where the road would lead. Leaning on Socractic wisdom he stated [20]:
“The basic data is so uncertain. It is not possible to know.”
Such transparency and wisdom should form the cornerstone of any risk assessment.
Support for self-regulation
There are many ways in which responsible citizens can promote their own resilience, sourcing:
- Vitamin C through fresh fruit and vegetables, lactobacteria or dietary supplements [21]
- Vitamin D from sunlight, fatty fish or as a dietary [22]
- Vitamin A from liver, sweet potatoes, carrots, along with some fat [23]
- Iron and zinc from offal, egg and dairy products, or dietary supplements [24]
- Immunomodulators with medical herbs such as Echinacea, Baptisia, Thuja, Eleutherococcus, Pelargonium and Uncaria [25] [26]
In addition to diet, these are proven ways in which you can support your immune system:
- Sufficient and restful sleep [27]
- Hardening, Kneippism and hydrotherapeutics [28] [29]
- Mental training and meditation [30]
Maintaining public health is a challenging task, especially in the case of scientifically uncertain forecasts. THE EPIDEMIOLOGY OF Covid-19 IS STILL BEING WRITTEN.
The primary task of politics in these times is to ensure public and private health systems, are able to respond to need, as well as to promote independent research to the best of their ability.
Our primary task as individuals, is to take proactive steps to remain as resilient as possible, strengthening our immune systems, where possible, to reduce the temporary overload of our respective health care systems.
Read about the project Immunity without Fear
References:
[1] https://www.ndr.de/nachrichten/info/coronaskript126.pdf
[2] https://de.wikipedia.org/wiki/Viren#Erforschungsgeschichte
[3] https://de.wikipedia.org/wiki/SARS-Pandemie_2002/2003#Abklang
[4] https://www.spiegel.de/wissenschaft/medizin/coronavirus-wie-sieht-die-zukunft-nach-dem-ausbruch-aus-a-4f1f91c6-eb02-4423-acbf-06fa25987914
[5] https://turismodeislascanarias.com/sites/default/files/promotur_indicadores_egt_2019_en.pdf
[6] https://countryeconomy.com/labour-force-survey/spain-autonomous-communities/canary-islands
[7] https://www.mincotur.gob.es/en-us/crisis-thomas-cook/Paginas/index.aspx
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609661/
[9] https://www.aerzteblatt.de/nachrichten/55880/Wirtschaftskrisen-erhoehen-Suizidrate
[10] https://www.apa.org/research/action/immune
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4465119/
[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361287/
[13] https://www.deutsche-apotheker-zeitung.de/daz-az/2020/daz-11-2020/mit-loeslichem-ace2-gegen-covid-19
[14] https://www.tk.de/techniker/gesundheit-und-medizin/behandlungen-und-medizin/copd/tk-plus-bei-copd/dmp-news/mikroorganismen-in-der-lunge-2059164
[15] https://www.charite.de/forschung/forschung_aktuell/pressemitteilung/artikel/detail/forscher_heben_immunblockade_gegen_bakterien_auf/
[16] https://www.ndr.de/nachrichten/info/coronaskript130.pdf
[17] https://www.health.harvard.edu/staying-healthy/how-to-boost-your-immune-system
[18] https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/aktuellt-epidemiologiskt-lage/
[19] https://www.covid.is/data
[20] https://www.di.se/nyheter/1400-folj-folkhalsomyndighetens-presskonferens/
[21] http://www.medizinfo.de/immunsystem/selbst/vitaminc.htm
[22] https://www.focus.de/gesundheit/gesundleben/vorsorge/news/vitamin-d-schluesselhormon-des-immunsystems_aid_487672.html
[23] https://de.wikipedia.org/wiki/Vitamin_A
[24] https://www.focus.de/gesundheit/ernaehrung/gesundessen/zink-hilft-bei-erkaeltung-zink-staerkt-immunsystem-haut-und-naegel_id_4723229.html
[25] https://www.aerzteblatt.de/archiv/8114/Pflanzliche-Immunmodulatoren-vermindern-Stressreaktionen
[26] http://phytotherapie.at/08_Bauer%20mod..pdf
[27] https://www.haz.de/Nachrichten/Wissen/Uebersicht/Neue-Studie-Wie-Schlaf-das-Immunsystem-staerkt
[28] https://www.focus.de/gesundheit/gesundleben/alternativmedizin/hydrotherapie/kneipptherapie/abhaertung_aid_21239.html
[29] https://www.planet-wissen.de/video-kaelte-trainiert-das-immunsystem–das-beispiel-wim-hof-100.html
[30] https://health.clevelandclinic.org/how-mindfulness-training-can-help-you-achieve-immunologic-health/
