“Give us the tools and we’ll finish the job”
This article discusses the structure and function of the immune system, what makes it over-reactive and the scientific basis for various therapeutic interventions. It goes on to discuss how it can be best supported in the battle against Covid-19.
Most people think that the immune system is a bit like a primitive warfare machine. However, on the contrary, it is highly sophisticated and intelligent beyond any human technology.
How does the immune system work?
Challenged by invading microbes, the immune system responds in two stages.
The first line of defence consists of the innate immune cells placed strategically to guard the borders. These engulf invading organisms, prepare the battlefield, identify invaders and pass this information to the adaptive immune system to organise itself for specific action.
The innate immune system response takes immediate, non-specific and temporary action until the adaptive system takes over within 3–5 days.
The adaptive immune system then completes the job by clearing the debris, cleansing the area and initiating healing, to bring the area back to normal.
The immune system launches an immune (inflammatory) response. Imagine if you had cut your finger. The area would be swollen, become red, warm and painful, and if the injury is big enough, you might lose the function of that part of the body. The immune response happens to clean the site of the cut and prepare for healing.
Components of the innate immune system
The innate immune system is made up of cells that work locally as well as their circulating counterparts.
Macrophages engulf microorganisms, continuing to eat up to 20 invaders each, before they die themselves.
Mast cells contain granulates of histamine and other vascular amines to increase the blood flow to the affected area.
Dendritic cells play the most interesting role in our intelligence service. They capture the invaders’ antigenicity (identity) in detail, pass this information to the adaptive immune system, so that it can launch a specific, targeted and effective attack against the invader.
The circulating members of the innate immune system are sub classes of white blood cells, including neutrophils, monocytes and basophils.
Neutrophils can be dangerously low in cancer patients after a course of chemo or radiotherapy, rendering the patient highly susceptible to any form of infection.
The circulating innate cells work by killing the invader microbes and die themselves during the battle. The combination of dead immune cells and the debris of dead organisms make of what we recognise as pus.
Components of the adaptive immune system
The Adaptive Immune system is composed of two types of cells: T-lymphocytes offer what is known as cell mediated immunity; B-lymphocytes produce antibodies to give humoral immunity. The activation of lymphocytes takes 3-5 days, after which the adaptive immune system gets ready to run the battle on its own.
T-cells become either TH1 or TH2, with TH1 being a pro-inflammatory limb, whilst TH2 is an anti-inflammatory limb. The system should keep the two activities in balance.
TH1 kills the invading organisms, whilst TH2 clears the rubble and by-products
B cells tag the invading organisms to make the body’s weaponry more effective and accurate.
There is a third type beyond T and B cells called the Natural Killer (NK) cells. These target the virus-infected cells to damage them using cytokines, in a very interesting way.
Every cell in the body contains a code-like identification known as Major Histo-Compatibility (MHC) proteins. Cells taken over by a virus lose their MHC code, making it possible for NK to find these cells and destroy them using cytokines.
The immune system uses chemical messengers known as cytokines to fuel the inflammatory response. Cytokines are divided into two main groups:
- Pro-inflammatory cytokines (such as IL-1A, IL-1B, TNF and IL-6) attack and kill the invading virus;
- Anti-inflammatory cytokines (IL-4, IL-7, IL-10 and IL-13) clean and repair the damage.
The lung cytokine storm
We have heard a lot about Covid-19 causing cytokine storms that destroy the lung, causing 6% of Covid-19 patients to require mechanical ventilation. Therefore, our ability to identify and treat these patients early has a huge impact on prevent the progression of the disease. Simply put, it will save lives. This is why I would like to review this area in a little more detail.
Many of us have had the chance to see images of Covid-19. The outer surface of the virus is made up of mushroom-like projections. These contain spike protein (S protein), which can rupture and destroy red blood cells.
Ruptured red blood cells release their haemoglobin content in the lung tissues. Haemoglobin is made up of two parts: haem is the iron-containing part that transports oxygen to the cells; globin is the protein that covers the iron-containing haem.
Iron, when covered, stays stable as Ferrous (Fe 2+); iron exposed to oxidation turns into the highly inflammatory ferric form (Fe3+). Therefore, iron exposure is like throwing gasoline on fire, causing severe inflammation and lung damage, resulting in Acute Respiratory Distress Syndrome (ARDS) and respiratory failure.
IL-6 is the cytokine associated with severe lung damage and high mortality in Covid-19 cases. This fact has stimulated a lot of interest in IL-6 inhibitors.
Reaching vulnerable patients early
We can prevent disease and save lives, if we can reach and treat those patients who are likely to progress to severe lung disease as early as possible. But how?
Carrying out Covid-19 tests would identify those with the disease but would not tell us if they were likely to progress to serious illness. There are some tests, however, that would help to predict individuals’ vulnerability:
CRP high, usually above 100
Lactic Dehydrogenase (LDH)
Albumin (if it is low)
Ferritin (if it is high)
Lymphocytes (if it is low – this test is historically used to segregate viral from bacterial infections)
In addition, you can check your level of vitamin D, which is the immune system conductor. And Homocysteine would indicate your Vitamin B status.
What treatment do I therefore recommend?
For vulnerable patients, early administering of a combination of Hydroxychloroquine and Azithromycin, plus oral and intravenous vitamin C, is likely to abort the infection, prevent further deterioration and the need for intensive care.
400mg twice daily for the first day and then
200mg twice daily for the remaining days
500mg twice daily for the first day
250mg twice daily for 5 days
Vitamin C: (given simultaneously)
10-20g IV once daily
500mg once every 2 hours
Hydroxychloroquine stops the virus hijacking the cell by pushing more zinc into it, zinc being a potent antiviral agent.
I have received many requests from my patients asking for hydroxychloroquine prescription. This is inappropriate as the drug causes high toxicity particularly to the heart, eye and nervous system, and the damage it causes may be permanent.
There are safe natural agents that could increase the concentration of zinc inside the cell. This include Quercetin and green tea extract. You can have these as supplements or in your food. Foods rich in Quercetin include onion, broccoli, apples, grapes and berries.
Vitamin C empowers the absorption of iron in the gut. I have found it very useful in the treatment of patients with iron deficiency.
Early evidence for the effectiveness of vitamin C in treating critically ill Covid-19 patients came from Dr Mao in Shanghai’s main hospital. He carried out a study on 50 patients with severe lung disease, who were given a high dose of between 10-20gram, intravenously for 5 days. All the patients survived. In addition, they left the hospital 3-5 days earlier than the average 30 day stay.
Vitamin C is mostly found as ascorbic acid, which is too acidic to be injected into the vein. Sodium Ascorbate is a better option, being fat-soluble and easily able to get inside the cells. On the other hand, ascorbic acid is well absorbed through the gut.
Giving intravenous and oral doses would ensure a good level of vitamin C inside and outside the cells, very helpful in these critical patients.
Zinc and Selenium
Zinc is absolutely vital, with a recommended dose of 30mg per day. Selenium at 200mg per day would boost and balance most patients’ immune systems.
Excellent sources of zinc include meat, shellfish, legumes such as lentils and beans, nuts, seeds and eggs.
Can you take pills to lower your temperature?
Non-steroidal anti-inflammatory drugs like aspirin and ibuprofen are not advisable because they can aggravate the condition or prolong it. A study published in BMJ has confirmed the use of Ibuprofen in respiratory infection caused more severe illness and complications.
There is no evidence that fever is bad for anyone as it is the body’s natural response to infection. However, it may cause convulsions in a few children with a condition known as fibral convulsion.
Again, paracetamol is not the best option as it is not free from side effects. In my experience, even as few as 10 paracetamol pills ingested together can cause acute hepatitis and liver failure.
What about vitamin D, Homocysteine and NAC?
Vitamin D is paramount to the overall success of Covid-19 treatment. In a study, a vitamin D dose halved hospital stays. A decent dose of Vitamin D should be offered to everyone in the UK during the epidemic.
Melatonin can calm the cytokine storm. The recommended dose is 50mg at night plus 30mg in divided doses during the day. Melatonin would also help to protect against heavy EMF (5Gs) now everywhere.
Patients with high Homocysteine would require the active forms of Vitamin B Complex (B6, 12 and folate) to boost their immune system.
I have a lot of experience with intravenous NAC to treat paracetamol overdose in hospital. Currently I use NAC for generating Glutathione, the master antioxidant.
My advice for the treatment of those with the disease is certainly different from what I would recommend for those generally trying to protect themselves, as some of the former could have side effects.
For the latter, vitamins C and D, plus zinc and selenium, are very important, in the doses outlined above.
However, no pharmaceutical intervention can really compensate for the deficiencies of a poor lifestyle. A natural diet, plentiful hydration, low stress, good sleep and enough exercise make up my prescription for your wonder treatment!