The COVID 19 virus, according to Skinner (2020) is a self-replicating infectious agent, which indicates that the infection can start with a small number of particles and that the dose can vary from one virus to another. When this dose reaches the respiratory tract, some cells will become infected and prepare to produce an infinity of new replicates, infecting the closest cells that, generally, include cells of the immune system, compromising it and repeating the process over and over again (Skinner, 2020). It should be noted that the speed with which the virus replicates and spreads will depend on the viral load to which people are exposed.
With COVID 19 there is a gap or risk between the reaction capacity of the Innate Immune System - IBS and the Acquired Immune Response, the latter is in charge of stopping, putting an end to the infection and remembering the immunity for this agent, with the purpose of responding quickly if the body were to be infected with said virus from now on (Skinner, 2020). But, what is this and in what way does it impact the spread of the virus and the mortality that is evident worldwide?
To understand it, it is necessary to know that IBS is one that "recognizes highly conserved danger signals in microorganisms and generates rapid and vigorous responses that eliminate more than 90% of the invasive agents" (para. 9), that is, it is the one in charge of preventing the virus from replicating and spreading through cells. On its speed of spread, depends not only the severity of the symptoms, but also the ability of the body to reject the infection.
In short, it is the immune system with which all individuals are born, which is in charge of preventing harmful materials from entering the body, being the first line of immune defense (Zepeda, Gvirtzman, Kreft, Inostroza, & Díaz, 2013). However, if the body is affected by other diseases or pathologies, the innate immune system will be weak and little provided with defense elements against a virus such as COVID 19, allowing its infectious agents to penetrate and spread easily and at a speed alarming, either because it does not have the necessary defense resources or because these resources are being divided to attack several diseases at once. At this stage, the body detects and initiates the assembly of a response (if it is able to do so,while the adaptive immune response kicks in).
The acquired or adaptive immune response is a specific response against the virus, it takes time to produce a primary infection (a virus that replicates rapidly as is the case of COVID 19) and its expression and severity depends on the number, virulence and the state of the subject's defenses (Moreno, 1983). The encounter with the virus can be natural as it has been presented in recent months in those infected with COVID 19 or it can be carried out in a targeted way through vaccines, if they exist. (Matta, 2011).
When the acquired or adaptive immune system lags behind, which is generally the case in older people, those with immunodeficiencies (such as asthma), or individuals who have received a very high viral load, the innate immune system continues to increase as the virus replicates and spreads., generating defense mechanisms, among which are coughing, sneezing and inflammation. "Inflammation is a defense mechanism that facilitates the arrival of cells of the immune system to the place where the aggression has occurred" (Information and Scientific News Service - SINC, 2018) this can be useful by initiating the contagion, since it helps contain the virus, but in the worst cases it can cause widespread damage to uninfected tissue, which, in practice, is what is causing a large number of fatal cases.
On the other hand, the viral load is the total amount of the virus that an individual has in his body, being higher in more serious patients according to the reports of the Ministry of Health of China (Skinner, 2020), as happens with the SARS. That is, the initial exposure to more viruses or a higher infectious dose, would increase the chances of infection and disease; it is important to emphasize that high dose or high viral load is as risky and lethal as repeated low dose exposure. Therefore, it is essential to limit any exposure to COVID 19, not only against individuals who have been infected and present symptoms such as cough, a defense mechanism that releases large amounts of virus, also against asymptomatic individuals, who hour after hour eliminate small amounts of the virus, just by talking.
Now, what is the relevance of viral load in the treatment and mitigation of the spread of COVID 19 and why is it so important to take it into account with reference to IBS and the adaptive immune response?
According to the statements made by immunologists, virologists and other specialists related to coronaviruses, if the viral load to which the individual is exposed is low, the IBS will have a greater capacity to slow down the replication and spread of COVID 19, keeping it alive until That the adaptive immune response is able to take effect, which can take between one and two weeks after infection (Skinner, 2020). Therefore, it is vital to bear in mind that, "The infection dose of the virus is more likely to cause an infection in the recipient the greater the amount of virus in the excreta" (Skinner, 2020). Also that:
The probability of transmission of the virus increases with the duration and frequency of exposure of an uninfected person with someone infected with the virus and that, the viral load, that is, the amount of virus that an infected individual is producing and that is potentially eliminating, (asymptomatic or not) will also affect transmission; the higher the viral load, the more contagious the person is (Skinner, 2020).
The contagion can occur through small droplets in the air, produced by sneezing, coughing or talking and that remain in the air for a few seconds. These droplets can be breathed in or land on some surfaces, thus surviving the virus for a period of time not yet determined with exactitude, but that, if someone touches it and then touches their mouth or nose, there is a great risk of becoming infected with the viral load that the individual (s) have eliminated on surfaces (Shour, 2020). From these approaches starts the importance of promoting hand washing as a precautionary measure and the use of masks to minimize contagion, especially caused by asymptomatic patients, since it is assumed that individuals who exhibit symptoms should immediately be placed in total isolation,while many others are in preventive isolation.
In this sense, Heneghan, Brassey, & Jefferson (2020), indicate that health collaborators are at greater risk, due to the numerous exposures to infected individuals, their contagion is enhanced according to the viral load they receive from the number of infected patients who attend daily. If a person receives viral load from five infected individuals, their contagion and disease can be five times enhanced and can be even more serious, if they are people with high viral load.
In accordance with the previous approaches, it is concluded that:
It is vitally important to find a bridge between innate immunity and adaptive immunity, such as the possible use of chloroquine or other drugs of similar action, an antiparasitic drug that belongs to the family of antimicrobial peptides and that, in cases of viral load high, immunodeficiencies or low defenses, speaking it in colloquial language, would help to inhibit actions of the virus (Ministry of Health, 2020; Melendez & Koznetsov, 2005), and to avoid extreme internal inflammation, while the response of the adaptive system arrives.
To avoid public exposure to high viral loads, it is necessary to limit as much as possible the use of mass transportation and the encounter of several individuals in closed rooms, to avoid high concentrations of viral load. (This may be the explanation of why China ultimately abruptly stopped all activity, obtaining really effective results, which are reflected in the decrease in infections and deaths).
Countries such as South Korea and Germany have managed to reduce mortality and make an intelligent isolation, not because of the culture of these nations, but, mainly, because of their health response capacity and budget allocated for this purpose, since they are doing between 15 thousand and 20 thousand COVID 19 tests daily (Pérez, 2020), not only to detect if individuals are positive for coronavirus, but also to determine their viral load, an aspect that helps to mitigate the virus in an effective and timely manner, and the possible delay of the adaptive system, which, as indicated in previous lines, causes the innate system to uncontrollably inflame some cells of the body. The jump that is occurring due to high viral load and other named situations,causes a massive response of the innate immune system, therefore, there will be obvious difficulties to control the virus and wait or allow the acquired immunity to activate, while at the same time it causes considerable inflammation and a cytokine storm (Skinner, 2020). This also suggests that it is the reason why in some countries health personnel are undergoing frequent examinations, even if they do not show symptoms.even if they have no symptoms.even if they have no symptoms.
It is necessary to completely end the lines that are being generated around various activities throughout the national territory, such as financial operations, delivery of bonds, payments of services, delivery of medicines, among others. The use of digital channels and home delivery of items should be encouraged. These lines are a source of contagion and although the State, governorships and mayors do not determine it this way, it is necessary, given the situation and what is stated in this writing, to refrain from doing them.
Total isolation should remain as long as the virus is active as soon as the vaccine that stimulates the production of antibodies and generates immunity in all citizens is not obtained. The monetary cost will be high, but the lethality generated by viral load and the lack of health capacity in Colombia can be efficiently mitigated. Otherwise, it would be advancing in a vicious circle that exposes an unfair paradox: That the country's economy remains active at the expense of life, both for those who go out to work so that others can isolate themselves at home, and for those who must go out daily to fight to save other lives. It is not just about making time to lower the curve while obtaining a vaccine, something else can be done, it is a matter of commitment, collaboration and investment,of each and every one of the actors involved. The number of people who concentrate in public and work places should be reduced as much as possible, because although the use of Chloroquine has been authorized to mitigate effects caused by the reaction of the immune system and to inhibit other actions of the virus, its effectiveness is It has usually occurred in cases that initially exhibit low viral load. An extreme situation like the current one needs equally extreme solutions.in cases that initially exhibit low viral load. An extreme situation like the current one needs equally extreme solutions.in cases that initially exhibit low viral load. An extreme situation like the current one needs equally extreme solutions.
Key words: Coronavirus, contagion, viral load, IBS - Innate Immune System, acquired or adaptive immune response, mortality, cytokine storm.
References
- Heneghan, C., Brassey, J., & Jefferson, T. (2020). SARS-CoV-2 viral load and the severity of COVID-19. Obtained from Oxford COVID-19 Evidence Service Team Center for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences. University of Oxford: https://www.cebm.net/covid-19/sars-cov-2-viral-load-and-the-severity-of-covid-19/Matta, N. (2011). Immune system and genetics: A different approach to the diversity of antibodies. Obtained from the National University of Colombia. Acta Biológica Colombiana, vol. 16, no. 3 pp. 177-187: https://www.redalyc.org/pdf/3190/319027888012.pdf Melendez, C., & Koznetsov, V. (2005). Quinolinic alkaloids: Biological importance and synthetic efforts. Obtained from the Laboratory of Organic and Biomolecular Chemistry, School of Chemistry, Universidad Industrial de Santander, AA 678, Bucaramanga,Colombia Universitas Scientiarum Vol 10, N ° 2, 5-18: https://revistas.javeriana.edu.co/index.php/scientarium/article/view/4975/3833 Ministry of Health. (2020). What you should know about the drugs that have been endorsed against covid-19. Obtained from El Tiempo: https://www.eltiempo.com/salud/claves-del-uso-de-medicamentos-cloroquina-y-la-hidroxicloroquina-contra-covid-en-colombia-481970Moreno, B. (1983). Tuberculous primary infection. Pathogenesis and clinic. Obtained from Dispensary of diseases of the thorax. Malaga. Archives of bronconeumology Vol. 19 Number 6.Pérez, I. (2020). COVID-19: South Korea does better. Retrieved from https://www.elnuevodia.com/opinion/columnas/covid19coreadelsurlohacemejor-columna-2552947/Shour, R. (2020). Does reducing COVID-19 viral load ameliorate severity of infection? Retrieved from https: //www.researchgate.net / post / Does_reducing_COVID-19_viral_load_ameliorate_severity_of_infectionSINC. (2018). They identify a new mechanism for controlling inflammation. Obtained from the Information and Scientific News Service: https://www.agenciasinc.es/Noticias/Identificar-un-nuevo-mecanismo-de-control-de-la-inflamacionSkinner, M. (2020). Expert reaction to questions about COVID-19 and viral load. Obtained from Science Media Center Zepeda, G., Gvirtzman, K., Kreft, J., Inostroza, E., & Díaz, P. (2013). Streptococcus pneumoniae and innate immunity. Obtained from Rev. chil. sick breathe. vol.29 no.2 Santiago vVrsión On-line ISSN 0717-7348: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0717-73482013000200005Obtained from the Information and Scientific News Service: https://www.agenciasinc.es/Noticias/Identificar-un-nuevo-mecanismo-de-control-de-la-inflamacionSkinner, M. (2020). Expert reaction to questions about COVID-19 and viral load. Obtained from Science Media Center Zepeda, G., Gvirtzman, K., Kreft, J., Inostroza, E., & Díaz, P. (2013). Streptococcus pneumoniae and innate immunity. Obtained from Rev. chil. sick breathe. vol.29 no.2 Santiago vVrsión On-line ISSN 0717-7348: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0717-73482013000200005Obtained from the Information and Scientific News Service: https://www.agenciasinc.es/Noticias/Identificar-un-nuevo-mecanismo-de-control-de-la-inflamacionSkinner, M. (2020). Expert reaction to questions about COVID-19 and viral load. Obtained from Science Media Center Zepeda, G., Gvirtzman, K., Kreft, J., Inostroza, E., & Díaz, P. (2013). Streptococcus pneumoniae and innate immunity. Obtained from Rev. chil. sick breathe. vol.29 no.2 Santiago vVrsión On-line ISSN 0717-7348: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0717-73482013000200005Kreft, J., Inostroza, E., & Díaz, P. (2013). Streptococcus pneumoniae and innate immunity. Obtained from Rev. chil. sick breathe. vol.29 no.2 Santiago vVrsión On-line ISSN 0717-7348: https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0717-73482013000200005Kreft, J., Inostroza, E., & Díaz, P. (2013). Streptococcus pneumoniae and innate immunity. Obtained from Rev. chil. sick breathe. vol.29 no.2 Santiago vVrsión On-line ISSN 0717-7348:
Notes
Neutrophils are the first cells that arrive and are put into action, in this case in the lungs to destroy the infection, but they also act on healthy tissue (immunopathology).
Patient with a disease or infection who does not experience symptoms.
Overproduction of various inflammatory mediators as a defensive immune reaction.
