4 weeks ago

Immunity to COVID-19: What does it mean and how can it be achieved?

Some of the most important unknowns with COVID-19 are as follows:

  • Do we know for sure if a person is immune to COVID-19 after infection?
  • What percentage of the U.S. population will be immune after this first wave of infections is over?
  • Will immunity last over time, or will it fade?
  • If and when a vaccine can produce immunity and stop the pandemic?

It’s helpful in thinking through these questions to understand how the immune system and immunity testing work. A viral infection begins when a virus enters a cell of your body. For the SARS-CoV-2 virus, which causes COVID-19, the spike protein on the viral surface attaches to a cell via a protein receptor on the cell’s surface called ACE-2 and lets itself in. The virus hijacks the cell’s machinery to make copies of itself. Those copies break out of the cell and then spread around your body. The viral copies enter more cells and make more copies, resulting in the death of the cells and disease.

The first type of immunity is known as the innate immune response. This is the base-level protection that everyone has to defend against infections even those the body has never seen the virus before. Once the virus is found, your cells “start secreting cytokines (signaling molecules)” to tell the neighboring cells that there’s a viral infection. Cytokines promote inflammation throughout the body. Inflammation is something that can make you feel sick, but it can also help stop the disease by killing the virus and/or attract cells and molecules that aid in the healing process.

Viruses have evolved ways to counter this initial response. Sometimes viruses produce so many cytokines that they trigger white blood cells to turn against healthy cells that can then lead to organ failure and death in a term called “cytokine storm.” It is unclear why some people develop this storm and not others, though there are indications that aging is a factor, as are underlying conditions like high blood pressure, diabetes or other conditions, which may alter immunity. With COVID-19 this “storm” can occur in the lungs, kidneys, brain, eyes, mouth, nose and even the skin on the toes.

The second type of immunity is called acquired immunity. With this type of immunity, the body actively secretes protein called antibodies. Antibodies are protein molecules that can kill viruses or, in the case of COVID-19, they block the attachment of the virus to the cell receptor. Antibodies are highly specific and can only interact with the virus, which induced the reaction. Antibodies against the SARS-CoV-2 virus are mostly found in the plasma (serum) and it can take from five to 10 days to be detected by most laboratory (serological) tests. However, research has shown with most viral infections can take up to two weeks to clear the virus.

However, not all antibodies can neutralize viral infections. In fact, some antibodies provide no useful propose. Therefore, detecting antibodies, which can react with SARS-CoV-2 virus may not tell the whole picture. Scientists need to perform additional tests to determine if those antibodies are functional against the virus.

Antibody tests

There are two main types of antibody tests. The first looks for antibodies and can be completed quickly. This is called an ELISA test (short for Enzyme Linked Immunosorbent Assay). This test doesn’t provide the most complete picture of immunity. Currently there are 250 kits available that use an ELISA, with sampling that can be done in testing areas or in cases in home using a small drop of blood; however, the FDA has only verified the validity of 12.

The second test is called a serum neutralization test, and it takes a few days to process and requires a larger amount of blood. It not only looks for antibodies, but also measures the ability of the antibodies to prevent the infection of a known amount of virus in destroying living cells in culture. Ideally, scientists will correlate the two tests and figure out which concentrations of antibodies that confer the highest level of immunity. It’s still not known what levels of antibodies are needed to have lasting, protective immunity. What also remains to be shown is whether the presence of antibodies means you can’t give the virus to someone else.

These tests are useful, but they don’t answer everything. As noted earlier, it takes days, if not weeks, for the body to produce antibodies, therefore a negative antibody test doesn’t mean the virus isn’t present. Since antibodies are produced during an infection and linger after it’s cleared, a positive antibody test doesn’t mean that the virus is no longer active.

However, deploying these tests will help answer a lot of questions. Most basically, it can help a person know if they have been exposed to SARS-CoV-2 virus. On a larger scale—if deployed in well-designed studies—serological tests could reveal the complete picture of the pandemic. They can also help scientists answer basic questions like:

  • How many people infected with the disease die?
  • What percentage of the population has been infected?
  • Who, and how many, may have spread it without knowing?

Serological tests could also potentially allow people who have immunity to return to work. That could be a huge boost to front-line health workers who may have been exposed to the virus, but are desperately needed back in action. Even if people do become immune, one thing that is not known is how long that immunity would last. That’s unfortunately not something that can determined until years of testing.

Scientists don’t understand why for some viral infections, your immunity never wanes. People who are immune to smallpox, for example, are immune for life. Less reassuring is that scientists have observed antibody levels to other coronaviruses (there are four coronavirus strains that infect people as the common cold) can last over a period of years. With the SARS virus infection antibodies can be detected in humans after four years and with MERS one year. These two are related coronaviruses, which have caused recent pandemics. However, no one can say at this time what the duration of immunity will be against the SARS-CoV-2 virus.

Over the long term, the immune system becomes less effective with advancing age and these older individuals can acquire more chronic illnesses that can hamper the response to a virus, even if their immune system recognizes. It will be years before scientists can understand what aging means for immunity to COVID-19.

Another problem seen with coronaviruses, is that their genome is unstable and mutations in the spike protein can occur. These mutations may lead to vaccination failure since the antibodies produced by a vaccine may not recognize the mutated spike protein. As is the case with influenza viruses new vaccines may need to be developed at regular intervals, which may take years to be determined. As of yet no such mutations in the SARS-COV-2 virus have been identified.

The CDC, various states and universities, medical research centers and governmental facilities around the world are now conducting serological surveys for SARS-CoV-2 viral antibodies. The tests are being done in public places in volunteers, which have never shown COVID-19 symptoms in an attempt to figure out who was previously infected with the virus. A survey like this can show the actual background rate of infection and answer critical questions like what proportion of people have been infected without showing symptoms and where the virus has spread in a population and quantify the overall rates of severe complications. Knowing these variables can help health officials better target interventions. This “contact tracing” is where trained staff interview people who have been diagnosed with COVID19 or tested positive with an antibody test to figure out who they have recently been in contact with. Then, they communicate with those people that may have been exposed to the virus, encouraging them to quarantine and/or be tested for the virus to prevent spreading the disease any further. It is part public health work and part investigation.

Preliminary results using antibody testing indicate that as many at 10 times the number of people have been infected, then the number of people that have been diagnosed with the disease. A medical term R0 tells the number of persons, which one person can infect. Current estimates of this value are between one and two depending on the geographical location of the outbreak. For a pandemic to be halted requires an R0 less than one.

Convalescent plasma

Another tactic under investigation is using convalescent plasma. The idea is to harvest the liquid part of blood, including proteins used for clotting, from people who have survived COVID-19. This plasma contains antibodies to the virus, so scientists are seeing whether it can help people with active infections get better. Researchers are also studying whether convalescent plasma can be used as a prophylactic to prevent COVID-19. Preliminary results so far are encouraging.

Researchers are also developing monoclonal antibodies in the laboratory against the virus in mice using genetically engineered systems. These antibodies could also be used to treat or prevent the disease. But antibody transfusions, whether they come from COVID-19 survivors or were created in a lab, only confer protection against the virus for a few months.

Long-term strategy of herd immunity

The long-term strategy is to have enough people in a population immune to the virus so that it no longer spreads easily. This is known as herd immunity. It usually requires between 70 and 90 percent of a group of people to be effective, depending on the contagiousness of the virus. Current estimates are that at least 70 percent of the population needs to have been infected to stop the COVID19 pandemic. With a large enough share of immunity in the population, even the remaining people who are not immune face a much lower likelihood of being infected. With few susceptible people in close proximity, pockets of infection quickly fade out.

Herd immunity can be achieved through vaccination or natural infection. According to the World Health Organization, there are currently 102 vaccines which are being developed by laboratories around the world using a variety of techniques, which have been used in the past to develop vaccines against both the SARS and MERS viruses. President Trump recently said he was personally in charge of “Operation Warp Speed” to get 300 million doses into American arms by January, which is a bold challenge indeed. Already, the administration has identified 14 vaccine projects. Combing resources of fewer research groups using different molecular platforms makes good sense.

An ideal vaccine would be molecular based containing only a portion of the spike protein gene and produce immunity in at least 90 percent of the recipients after only one application with only minimal adverse reactions in a small percentage of recipients. It will also need to prevent replication of the virus (sterile immunity) and provide this level protection for at least one year. However, it will need to be determined if a booster administration is needed especially during the first year of use.

There are eight vaccines currently being tested in humans in five different countries. This is necessary if countries limit their early vaccines to their own population. Commercial vaccines are normally licensed in three phases. The first two are primarily for safety and the three for protection (as measured by the ability to produce neutralizing antibodies). This process normally takes from 12 to 18 months to complete. Two of the aforementioned vaccines are now entering phase two. Due to the necessity to rush this vaccine into the market to prevent the world’s economy from collapsing, this entire process has been accelerated and scientists hope to have a safe efficacious vaccine for first responders by the end of the year and for the general population sometime next year. However, the timing for the production and distribution of a vaccine for this goal to achieve herd immunity is unknown since the medical infrastructure for viral or antibody testing and administration of a vaccine in underdeveloped countries is poor and hampered by poverty, governmental corruption, war and lawlessness. In addition, even in developed countries, a mistrust for scientific and vaccination data is often communicated through social media. Estimates to vaccinate 70 percent of the world population may exceed $25 billion.

One thing that is accepted by most scientists and medical experts is that rushing too fast to approve and distribute a vaccine is a gamble since the vaccine(s) may not provide effective long-term immunity and may cause as yet unknown adverse reactions. In addition, some companies are willing to perform a challenge infection, which intentionally infects young, vaccinated volunteers with live SARS-CoV-2. However, this is dangerous, because no one can say what the virus will do in people if the vaccine does not work. These challenge studies have been successfully undertaken in several monkey species in the lab, but how this translates in humans is unknown.

There are presently a number of companies in several countries that are building facilities to mass-produce a commercially licensed vaccine. However, there is probably no need to vaccinate the entire population, because in a year at least 20 percent of the world’s population could have already been to be exposed to the virus. The caveat of not finding a successful vaccine by next spring is that it will take some time in 2021 or 2022 before we reach heard immunity. If that is the case, then plan B to develop and test antivirals in sick humans becomes a necessity to treat the 100s of millions of people who will become seriously ill due to COVID19.

Obliviously there are many questions that have been answered about this virus over the past four months, however, there are many more that have remain unanswered. How fast we answer these remaining questions no one can say.

Joseph Giambrone is a professor emeritus in Auburn University’s Department of Poultry Science with a joint appointment in the Department of Pathobiology in the College of Veterinary Medicine. During his graduate research career at the University of Delaware, he was part of a research group that developed the first vaccine against an antigenic variant of an avian coronavirus. During a sabbatical leave during his tenure at Auburn, he was part of a research group in Australia that sequenced the entire genome of antigenic variant of a coronavirus of chickens. During his 42-year research career as a molecular virologist, immunologist and epidemiologist, he has made critical advancements in understanding the ecology of viral pathogens, led efforts to improve detection and surveillance of viral diseases and developed new and effective vaccines and vaccine strategies to protect commercially reared chickens as well as pathogens, such as avian influenza viruses, which have spilled over into human populations. His research has had a profound impact on practices used today to reduce the incidence and severity of viral diseases of commercially reared poultry as well in human populations.

11 hours ago

Fmr Gov. Don Siegelman appears to be using outrage over George Floyd to sell new book

Former Alabama Governor Don Siegelman to sell his new book is using robocalls that appear to reference the current unrest over George Floyd’s death while in Minneapolis police custody.

On Thursday afternoon, a Yellowhammer News reporter received a robocall from 1 (800) 890-5875, a number listed as “Robocaller” by the phone protection company NoMoRobo. The voiceover of the robocall was apparently recorded by Siegelman himself.

The message began, “Don Siegelman, your governor here. We’ve got to protect people from the abuse of power by police, prosecutors, or presidents.”

“My new book, Stealing our Democracy, is a wakeup call to action. It’s also number one among new releases on amazon.com,” the message added.

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An individual from the Wiregrass told Yellowhammer News that she also received the voicemail.

In addition to that, at least one Twitter user appeared to have received the robocall.

Siegelman was convicted on June 29, 2006, of conspiracy, bribery and fraud.

The former Alabama Democratic governor appeared to lump in his claimed unjust treatment by the authorities with the death of George Floyd.

Listen:

Siegelman is currently promoting his new book “Stealing Our Democracy.”

Yellowhammer News’ request for comment from Siegelman was not immediately returned. A message was left on his personal cell phone number.

He claimed the book is “#1 among new releases on amazon.com”

Yellowhammer News examined the new releases chart on Amazon.com, which revealed that Siegelman’s book is not in the top 100 best selling new releases.

However, the book is #1 in the sub-subcategory “Urban, State & Local Government Law.”

Urban, State & Local Government Law is one of 12 sub-subcategories of the “Administrative Law” subcategory.

The “Administrative Law” subcategory is one of 23 subcategories under the category “Law.”

“Law” is one of 36 categories into which Amazon divides the kinds new-release books that it sells.

As a matter of record, the book is only available for pre-order. It has not been released to the public yet.

The former governor’s book claims that his downfall and conviction of felony bribery were part of a politically motivated prosecution coordinated by Karl Rove.

His book will be released to the public on June 16.

Henry Thornton is a staff writer for Yellowhammer News. You can contact him by email: henry@yellowhammernews.com or on Twitter @HenryThornton95

11 hours ago

Two charged with capital murder in slaying of Moody PD officer

Two suspects have been charged with capital murder in the case of slain Moody Police Department officer Stephen Williams.

The two suspects are 27-year-old male Tapero Corlene Johnson and 28-year-old female Marquisha Anissa Tyson. Both are from Birmingham and will be eligible for the death penalty if convicted.

At a press conference Friday, St. Clair County Sheriff Billy Murray described said the investigation is still continuing and described it as “complex and intense.”

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Williams was posthumously promoted to lieutenant at the press conference on Thursday by Moody Police Chief Thomas Hunt.

Hunt said Williams had remarked at times that he would like to achieve the rank of lieutenant someday, and now he will forever be known as Lt. Stephen Williams.

The District Attorney for St. Clair County said the two suspects had been in police custody since the shooting on Tuesday night.

Investigators say they have determined that Johnson and Tyson fired weapons at Williams who was responding to a disturbance at a Super 8 Motel.

A GoFundMe page to help Williams’ family has been raising money in recent days.

Williams served the public as a police officer for 23 years before being killed in the line of duty this week.

Governor Kay Ivey commented on the incident earlier in the week, saying Williams “died a hero.”

Henry Thornton is a staff writer for Yellowhammer News. You can contact him by email: henry@yellowhammernews.com or on Twitter @HenryThornton95

12 hours ago

Data shows Alabama nursing homes performing better than national average for COVID-19 cases, deaths

The Centers for Medicare and Medicaid Services on Thursday released facility-specific COVID-19 data for nursing homes across the United States, and an analysis of the data shows Alabama fairing better than the national average.

The data was collected on a mandatory basis by the CDC and currently covers through the week ending on May 31.

Nationwide, the average number of confirmed coronavirus cases per 1,000 residents in nursing homes was 91.2, while the average number of deaths from the disease per 1,000 residents was 30.2.

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In Alabama, both of those numbers were significantly lower than the national average, at 64.9 and 20.9, respectively.

Alabama Nursing Home Association president and CEO Brandon Farmer issued a statement on the data’s release.

“According to the Centers for Medicare and Medicaid Services (CMS), Alabama nursing homes report fewer cases of COVID-19 per 1,000 residents and fewer deaths from COVID-19 per 1,000 residents than the national average,” he confirmed.

“Because we are on the front lines of fighting COVID-19, we expect the number of COVID-19 cases to rise as more tests are administered and the data is added to the Centers for Disease Control and Prevention (CDC) system. The Alabama Nursing Home Association hopes this data will be used to prioritize resources for skilled nursing facilities,” Farmer advised.

“Alabama nursing homes have been transparent from the beginning of the COVID-19 pandemic,” he continued. “Our members have reported cases to their local county health department and the Alabama Department of Public Health from the start. In May, we began reporting cases to the CDC. Facilities also inform residents and their family representatives and employees of cases in their buildings. We are following the guidelines set forth by the multiple state and federal agencies that regulate our sector. No other business or health care provider reports COVID-19 cases to more government entities and people than nursing homes.”

Nationwide, nursing homes reported 95,515 confirmed COVID-19 cases and 31,782 deaths through May 31. Nursing homes in Alabama reported 1,000 confirmed cases and 335 deaths.

Moving forward, CMS will release the next round of data on June 18. After that date, new data should be released weekly.

“The Alabama Nursing Home Association and its members will continue to work with local, state and federal leaders to address the needs of nursing home residents and employees,” Farmer concluded.

The CMS data can be viewed here.

As of Friday at 2:00 p.m., the Alabama Department of Public Health reported 19,073 total confirmed COVID-19 cases in the state, with 672 deaths.

Sean Ross is the editor of Yellowhammer News. You can follow him on Twitter @sean_yhn

13 hours ago

NFIB survey of Alabama business owners shows ongoing COVID-19 related fears

A new study from the National Federation of Independent Businesses (NFIB) showed that an overwhelming majority of proprietors are nervous about several aspects of how the coronavirus pandemic is affecting their business.

Yellowhammer News reported in the first week of May that 70% of the NFIB’s membership across the United States was concerned about individuals filing frivolous lawsuits claiming a business had caused them to catch COVID-19.

A poll from the Alabama division of NFIB this week shows that 69% of businesses in the Yellowhammer State remain nervous about lawsuits, and roughly equal amounts are worried whether customers might come back and that it may prove difficult to comply with ongoing regulations.

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The top results of the survey as follows:

  • 70% of owners say they’re very or moderately concerned about getting customers back.
  • 69% are concerned about managing the health and safety of their customers; 66% are concerned about managing the health and safety of employees.
  • 69% are concerned with having to comply with new regulations related to the coronavirus.
  • 68% are concerned about finding an adequate supply of supplies such as hand sanitizer and disinfectant.

NFIB state director Rosemary Elebash told Yellowhammer News Friday that the survey was administered to businesses in every county and every city with a significant population.

“It wasn’t just NFIB members,” Elebash added about the survey, saying the group had worked with a number of trade associations to increase the amount of responses.

The NFIB also continues to strongly support Senator Arthur Orr’s (R-Decatur) bill to grant civil immunity from COVID-19 lawsuits to businesses in Alabama.

Elebash noted in a release that Orr’s bill would be “one of NFIB’s top priorities” if Governor Kay Ivey calls a special session later in the year.

Henry Thornton is a staff writer for Yellowhammer News. You can contact him by email: henry@yellowhammernews.com or on Twitter @HenryThornton95

13 hours ago

Tuberville: Nationwide unrest linked to ‘education and jobs’

Many argue there is much more to the civil unrest across the nation than the lone incident in Minneapolis involving the death of George Floyd while in the custody of the police department. Former Auburn head football coach Tommy Tuberville indicated he agrees with that.

During an appearance on Huntsville WVNN’s “The Jeff Poor Show,” Tuberville, a candidate for U.S. Senate, said based on his interactions with people on the campaign trail, there is a longing to get back to a sense of normalcy in the wake of the heights of the COVID-19 pandemic.

“I speak to eight to ten places a day — groups are worried, obviously. I think they’re getting a little more confident they can go out and be around other people,” he said. “And we’re just hoping we can just put this pandemic, and it is a problem, it is serious — again, you’ve got to protect yourself. It’s not going away. It is still here, especially if you’re having health problems and those things. That will go away — but then all of a sudden we get hit with this civil unrest, and again — we’re all Americans. We’re all in this together. We’ve got to find a solution.”

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Tuberville said he is asked for his thoughts by voters while on the trail, to which he said he points to “education and jobs,” and the erosion of the American middle class.

“I had a group ask me today, ‘Coach, what do you think the problem is?’ Education and jobs. We don’t have a middle class anymore,” Tuberville stated. “There are people out there that don’t have the opportunity to advance in this country like they want to. This is not a black issue. This is not a white issue. This is an American issue. We shipped our jobs to China, bottom line. We’re finding out more and more about that every day, and we’ve got to give the opportunity for young men and women to have a chance to grow in this country, and give them a fair chance. Unfortunately, our middle class has dissipated. We have more drugs in this country, and a lot of people take other options. We got to understand — we’re all in this together, 340 million people. We’re either going to make it together or not make together.”

@Jeff_Poor is a graduate of Auburn University and the University of South Alabama, the editor of Breitbart TV, a columnist for Mobile’s Lagniappe Weekly and host of Huntsville’s “The Jeff Poor Show” from 2-5 p.m. on WVNN.