Immune system: Vaccines, travel and various factors
Most intelligent organisms adapt. We adapt by learning and growing. We learn by observations and collecting data.
As per previous comments regarding respiratory viruses and the immune system, most viruses adapt. The immune system of most individuals are equipped and designed to respond to infections and manage biological risk appropriately, however, the human’s immune system is complex and sometimes fragile. The immune system also has to learn, grow and adapt, depending on different stimuli, agents or risks, however recommending and enforcing a context of a non-changeable, semi-permanent, semi-sterile environment, such as ‘stay at home’ initiatives, will likely not assist in these matters for many. Closing borders and preventing travel will likely not assist in these matters either. The opposite is likely true and required for most healthy individuals’ immune systems to learn, adapt, grow and function appropriately in risk associated contexts, such as these.
Staying at home for instance during ‘stay at home’ messages or lockdown can prevent the immune system from exposure to agents that stimulate learning, growing and adapting of the immune system for many individuals (we are not referring to infections when we use the word exposure and we do not recommend in any way that you purposefully expose yourself to anyone with an active infection or who tested positive – this will likely increase risk markedly). Healthcare workers or carers who are exposed to individuals with active infections or individuals who test positive take appropriate clinical precautions to protect themselves.
Many doctors report that when they start working in another country, they often present with minor respiratory infections or irritations for the first few months and sometimes up to two years, which then ends. This is likely due to general exposure in a new community or country. Many doctors believe that their “body and immune system is getting used to the bugs of the area and then the body and immune system adapt and you don’t get sick or feel any irritations any more, I even see it when relatives come to visit, they are so often a bit sick, but very minor, because they are not used to the bugs”, as reported by a medical doctor. Exposure can lead to infections, especially with sudden, going from zero to ten, significant exposure, such as moving to another country, far from your home country, in winter time and starting to work in hospitals full time with on calls, without delay or a gradual induction, whereas gradual, minor and regular exposure often prevents significant or serious infections, as many medical doctors agree.
Timing is essential in some circumstances when making decisions regarding various initiatives, and as mentioned before, individuals at high risk for severe COVID-19 require different protocols to facilitate equal protection (such as urgent vaccines with a clinical urgency to be fully vaccinated), however, autonomy, liberty and normalcy are important protective factors for all.
The immune system can also be harmed significantly by factors such as chronic anxiety, low mood, nihilism (‘no hope’), ‘feeling trapped or stuck’, deprivation of liberty, deprivation of autonomy and deprivation of normalcy. This is why lifestyle, such as spending time outdoors in nature, camping, hiking, boating and adventure or enjoyment, is very important. Mental state is important; calm, positive thoughts with feelings of ‘freedom’, ’empowerment’ and hope, along with good insight based on good education to prevent illness and infections, and what to do if concerned. These items are important because they contribute to, promote and sustain, a healthy immune system, which markedly affects general health outcomes. Most professionals who work with deprivation of liberty have extensive clinical knowledge and expertise to share, supporting these concerns. Please see previous two posts on deprivation of liberty and the immune system.
It is important to consider that immunity secondary to vaccines or active infections often does not last. In some infective diseases immunity may be life-long further to various vaccines or further to infections, however, it is the current understanding that immunity for this virus, secondary to a vaccine, will likely not last more than a year, likely 9 months more or less. Most agree that vaccines provide a degree of protection (although not 100%, sometimes may vary between 75-95%) in the context of preventing hospitalisation and reduced mortality rates, and that vaccines are one of the tools in the tool box to prevent infections. Continued diligence is required to prevent infections such as washing hands, covering nose and mouth when sneezing or coughing, avoiding sharing eg utensils or drinks, remaining at home if sick, symptoms or positive tests, along with eating healthy, remaining calm and regular enjoyment. Interpersonal variation is also sometimes relevant, where some individuals will respond differently in terms of vaccines.
“80% of the time COVID-19 is a mild disease that feels like a minor cold or cough”, as reported by Prof Peter Piot, Director for The London School of Hygiene and Tropical Medicine, and 95.5% of the general population will likely not require hospitalisation, only 4.5% of the global population will likely require hospitalisation if infected with SARS-CoV-2, as reported by The London School of Hygiene and Tropical Medicine. “Earlier estimates that 80% of infections are asymptomatic were too high and have since been revised down to between 17% and 20% of people with infections.” https://www.bmj.com/content/371/bmj.m4851
It is important to consider that these statistics were relevant in a clinical context without vaccines.
We have to ask ourselves, whether we will ask the public to engage in annual vaccines for a viral infection where more or less 80% of the global population will likely experience a mild cold or minor flu and no serious symptoms if actively infected. We have to ask ourselves how long will we ask travellers (with and without vaccines) to engage in 7 PCR tests (risk associated invasive nasopharyngeal tests) within 10 days for travel related purposes (no clinical indications) at more or less £100 per PCR test. We have to first do no harm, at all times.
Immunity due to everyday exposure (not infection or vaccine) is relevant and important, which is one of the reasons many medical doctors have advised that liberty is not deprived by lockdown or stay at home or quarantine, and travel not be discontinued in any way; immunity in this context will likely continue, as individuals will continue with exposure by regular travel and daily life. As mentioned earlier, we have travelled through more or less 20 countries during the pandemic, usually for work and within high risk areas, and have never presented with any symptoms, an elevated temperature or a positive test since the onset of the pandemic in January 2020 (our trip started mid January in Asia) – it is relevant to know that all flights during the first 5 months, except for one, did not require face masks – more than one specifically asked that face masks not be worn. We travelled through at least 10 countries, most in Asia, during this time.
Risk usually has to be balanced carefully; often when one extreme approach is taken to reduce risk, risk increases markedly in other contexts eg social contexts or psychological context or other biological or medical contexts, and when risk is ignored completely with a laissez-faire approach, risk often continues to increase unnecessarily. A careful balance is required and can be achieved by asking individuals with appropriate, clinical training and experience in bio-psycho-social risk assessment and risk management to contribute to the discussion.
Our work with children with poor immune systems due to a range of difficulties including eg infective diseases such as HIV, nutritional problems or an environment of threat and anxiety, has inspired us to take a systemic approach at all times. It is essential to understand that biological factors such as infections, psychological factors such as anxiety or ‘feeling trapped’ or ‘feeling forced’ and social factors such as being asked to remain in the same space for a few days, can increase risk to present with infective diseases significantly for most individuals via the negative effect on the immune system.
As mentioned earlier, mental state is an essential predisposing, precipitating and maintaining factor for general health (and mental health). Mental state markedly affects the immune system. A mental state of calm, confidence, positive thoughts, feelings of freedom, autonomy (“being in control of one’s life, the comings and goings, it keeps people healthy”, as reported by a medical doctor), normalcy (that “things are normal”, as reported by medical doctor) and empowerment (“we know how to stay healthy”, as reported by an individual living in an informal settlement), as well as calm, positive behaviours along with insight based on good education regarding the risks associated with the infection and the options to manage risk appropriately (based on good clinical evidence) is of significant benefit to general health.
We were interested in the different mental states in the different countries. It is important to consider that mental state, like risk, is dynamic, and varies from moment to moment, based on context and bio-psycho-social factors.
Statements or quotations in South Africa:
1. “We are fine here, we are healthy, …, we are happy, it is what we do, it is what we always do. We know HIV, we know TB, we know how to stay healthy and if HIV did not get us, this will not get us.” Community elder in a location
2. “We are doing very well actually, the problems we have are not related to the pandemic, it is the problems we’ve always had, but now they are taking a backseat …, but from a pandemic point of view we are all very lucky here, I wouldn’t be anywhere else if you paid me.” Medical specialist working in an informal settlement
3. “Things are not bad in South Africa, our winters are not really winters, they are mild, like European summer, actually I see most people are very healthy, most people here are happier and healthier than before, I think it is because they look after themselves better now, they eat better, they rest more, I don’t want to be in a place where there is so much fear …, I am happy here.” Medical doctor
4. “I worry now that we have had good results in …, people are becoming ‘hans’ (over confident), they are not greeting with elbows any more, they are back to hugging and kissing, we see party busses, parties in restaurants acting as clubs, people say they better get their social on, because lockdown is coming again – this is a problem, because some people base behaviour on lockdown rules, rather than infection risks, so before or after lockdown they go crazy, rather than think ‘infection risk’ – the story was not pitched as ‘protect yourself’ to all, it was more ‘avoid lockdown’ … for some which won’t help”. Medical doctor
5. “Things were very bad when you weren’t allowed to leave your homes, the military soldiers were outside our houses and said we couldn’t stand on our own lawn, .., the kids were so frightened they didn’t eat or sleep, but now we can live again. Although my son hasn’t spoken in months, his therapist says it is the masks.” Mother, baker
It is important that good clinical evidence is followed in every context to reduce risk and to prevent harm, to protect yourself and the general public. We need to ask questions and educate ourselves based on good clinical evidence.
Prevention: Following only good clinical evidence
The most important and essential strategy in Medicine or Health is prevention. We are sharing this information for this purpose. Much of the morbidity and mortality outcomes can be prevented if a systemic, evidence-based (only based on good clinical evidence) bio-psycho-social approach is followed, including relevant risk and protective factors.
We have to ask whether there is good clinical evidence to support initiatives in the general public. We have to ask these questions whilst still following local laws and rules.
The World Health Organisation and the European CDC have clear guidelines in terms of when a mask may be helpful, as posted earlier.
WHO – “At present there is only limited and inconsistent scientific evidence to support the effectiveness of masking healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2” World Health Organisation. More details available at https://apps.who.int/iris/rest/bitstreams/1319378/retrieve.
European CDC – “There is limited evidence on the effectiveness of medical face masks for the prevention of COVID-19 in the community.” ECDC, European Centre for Disease Prevention and Control https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-face-masks-community-first-update.pdf
It is our understanding that the CDC has now advised that face masks not be worn outside when social distancing is possible, which is congruent with current UK guidelines. We understand that Disney recently changed their mask wearing policy allowing guests to not wear masks outdoors in contexts that are clinically appropriate. We understand that the UK plans (hopes) to end all mask wearing, indoors and outdoors, in June 2021.
Asking questions, finding evidence-based answers (based on good clinical evidence) moves us forward.
Education is essential to prevent illness or infective diseases.
For Educational Purposes – we have observed than many report various different symptoms as the ‘most common’ symptoms. Please see helpful links (details of where links were founded on photographs).
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