People who become infected with COVID-19 have to fight the disease off with their own immune system.
However once the virus has been booted out, it's hoped people will gain a natural immunity, like those infected with influenza do. Antibody tests are one way to check if someone has this natural immunity, and
so the UK has ordered 3.5 million of of them.The SMC asked experts to comment on COVID-19 immunity issues relating to:The immune system and antibody testingSleep (and lack of)How to keep a healthy dietThe UK's testingAssociate Professor Helen Petousis-Harris, vaccinologist, University of Auckland, comments:
"To know for sure that having COVID-19 makes people immune to getting reinfected we need to see if those who have
recovered get it again. So far there is no good data that this happens, although there can also be exceptions.
"The general thinking is that protection for at least a few years is likely, based on what we know about other
coronaviruses. With the common human coronaviruses that cause colds we know that people make immune responses and have
antibodies, but after a few years they can get reinfected. We do not know if this is the case with SARS and MERS.
"Assuming people become immune for a while, there is no way to know how long the protection will last, but I imagine it
will be at the very least a few years.
"An antibody test will undoubtedly be very useful for indicating if someone has been infected. It won’t tell you for
sure if the person is protected because we will not know what correlates with being protected for a while, if ever.
However, if we become confident that recovered people are immune to reinfection this will be very useful indeed.
"If someone gets infected the best defence they have is their immune system. There are some scientifically proven ways
to optimise the function of the immune system. Those backed by really good research are: Eating as well as possible;
getting a bit of exercise (not ultra marathons); and the value of sleep on the performance of the immune system cannot
be understated.
"Also, as we know, over time stress can have a negative impact on immunity. During this very stressful time we need to
value the importance of looking after our physical and mental health. Spending a fortune on vitamins and potions is
unlikely to be helpful."
No conflict of interest.Dr Nikki Moreland, Senior Lecturer in Immunology, University of Auckland, comments:
"What normally happens after a viral infection is that your immune system develops an early response, this includes IgM
antibodies. In the later stage of infection you get a more mature response, this includes IgG antibodies. These IgG
antibodies generally give people longer term protection to a virus.
"There are two different ways that scientists are approaching antibody tests for COVID-19. The first way is the
traditional lab-based antibody test from a blood sample, which gives information on the level and type of COVID-19
antibodies someone has in their blood. These tests need to be run in a laboratory and provide doctors and scientists
important data to understand that immune response to COVID-19. The other way that scientists are looking to develop
antibody tests are quick point-of-care tests. These are based on little lateral flow devices, like a pregnancy dipstick
test. You put a finger prick of blood on a wick and within a few minutes you have a quick ‘yes or no’ answer as to
whether someone has antibodies to COVID-19.
"The quick tests are receiving a lot of media attention at the moment, with many groups racing to develop them. They
would be good for testing out in the community, and also for frontline healthcare workers, but we also need data on the
level and types of antibodies people have – so we can understand the long-term immune response – and for this we need
the more traditional lab-based tests.
"A lot of people are getting the virus and recovering, and when scientists have looked in their blood, they've seen
traditional signs of a mature immune response – good levels of IgG antibodies, and evidence that immune cells have
activated and responded to the virus. But there is still not enough research published for us to have a clear
understanding idea of the immune response to COVID-19.
"In terms of ensuring that you're going to have a robust immune response – a good healthy diet, getting rest, and
generally looking after your body as best you can. All of these things help."
No conflict of interest.Dr Rosie Gibson, Research Officer at the Sleep/Wake Research Centre, Massey University, comments:
"Sleep provides a foundation for our physical and mental wellbeing. It also boosts the effectiveness of special cells
involved with the body’s immune response. The Covid-19 pandemic has dealt a time of acute stressors and rapid
sociological changes. Losing sleep over this situation is to be expected.
"But, as we acclimatise to this period of lockdown, it is important to consider sleep as a natural tonic. Sleep will
help us to psychologically adapt to our changing circumstances while also defending us against disease and supporting
healing.
"Achieving sufficient hours of sleep is important but so is the timing and regularity of sleep. Maintaining consistent
routines may become more challenging whilst in lockdown. Our internal body clock and sleep/wake cycle is synchronised
via exposures to external time cues. Light, physical activity and social engagement are key so try to maintain regular
exposures during lockdown. Consider scheduling morning tea breaks in natural light, working from the garden or by a
window, and avoid using brightly lit devices too much at night. Taking routine solitary exercise outside is recommended,
timing this when we would typically commute or socialise will help.
"Being physically separated does not mean sacrificing all social stimulation. Try to schedule family meal or game times
(in person or online), virtual meeting dates with colleagues and phone conversations with family and friends. Creating
and maintaining consistent exposures to these time cues will not only stimulate good sleep but will support overall
wellbeing and help keep us connected.
"Blending work with family environments can impact sleep, mental health, and productivity. This will be exacerbated in
this time of uncertainty. If possible, keep the bed and bedroom predominantly for sleep. Exposing ourselves to the news
or using brightly lit devices the hour or two before bed can prevent relaxation and destabilise the sleep rhythms. Make
the time to wind-down and talk through or write down concerns before attempting sleep. If you struggle to get to sleep
or wake up in the night and cannot get back to sleep, do something calming in another space and return to bed when tired
again.
"Try to maintain routine rise and work/activity times. Get dressed for the day and avoid the temptation to work from
bed. If consuming alcohol or caffeine consider how and when you do as this can reduce the efficiency of sleep as well as
contribute to anxiety. Sleep loss during this time will be common, be aware of how you feel in the day and schedule a
nap if needed.
"During this lockdown period we must appreciate the sleep schedules of others. For example, older people are often
synchronised to sleeping earlier and are more easily woken at night. Support one another, especially the older and
vulnerable, to maintain healthy sleeping practices. This will strengthen our immune systems and support wellbeing during
this extraordinary time.
"All that said, I am writing this in the early hours of the morning, still in PJs while the children watch TV instead of
their school routine. There are gaps between health advice and reality and people shouldn't become overly stressed with
guidance, particularly in this rapidly changing time."
No conflict of interest.Emeritus Professor Elaine Rush, Professor of Nutrition, Auckland University of Technology, comments:
"In these extraordinary times of unprecedented physical distancing there is opportunity and challenge. New Zealand is in
the fortunate position of growing enough wholesome foods for everyone.
"Worldwide experts agree that a diet of a combination of wholesome, relatively unprocessed foods – mainly plants – is
best for health, immunity and longevity. In addition physical movement such as walking and the fellowship of sharing, in
your bubble and virtually with others, are vital. Three Fs: food, feet and fellowship. These all help the immune system
to do its work."The overall quality of a diet is judged by its diversity, whole food characteristics and quantities of
each food. In the shopping trolley (or from the garden and pantry) and on the plates a general rule is that almost half
the volume (not weight) should be vegetables that grow above the ground, these are coloured and in particular dark green
leafy vegetables such as spinach, silverbeet, Chinese cabbage, and pūwhā, which are good sources of vitamin A and
antioxidants which support the immune system. With the addition of fruit including citrus or kiwi for vitamin C, half
the trolley is completed. The next quarter is good sources of protein that may include milk, beans, eggs, milk and
cheese, and the final quarter starchy staples such as potatoes, rice and pasta.
"A supply of vegetables and fruit can be stored as frozen or canned which are just as good nutritionally. In addition
ingredients that make food tasty, garlic, spices and herbs, are important. Food must be enjoyed and celebrated.
"The challenge is to ensure that good food reaches those most in need, that in a household there is enough money for
food, and that food for health and recovery are a priority."
No conflict of interest.
Professor David Wraith, Professor of Immunology and Director of the Institute of Immunology and Immunotherapy at the
University of Birmingham, comments:
"Various companies have recently reported development of tests for anti-SARS-CoV-2 antibodies, including the
finger-prick assay that is to be used in the UK. At present these are not extensively tested but will give a +/- readout
of immune status.
"Scientific publications released this week, show that it will be possible to establish a more accurate way to detect
anti-SARS-CoV-2 antibodies. This is important because antibody tests will give us a safe way to judge whether or not
someone is infected since we now know that antibodies appear shortly after symptoms.
"This will allow us to distinguish those people who have had SARS-CoV-2 versus the many other bugs that are flying
around at this time of year and can give similar symptoms. This is a key point: the information provided will tell us
who among individuals in our [health service] and other essential workforces are immune to the virus and, therefore,
safe to return to their vital work.
"For many people, it is difficult to know whether they have had a cold, flu or SARS-CoV-2: if these individuals don’t
need to self-isolate for long periods then they can return to the critical workforce confident that they have built up
immunity to the infection. However, a more sophisticated test than those currently available is required to assess the
type and strength of immunity that correlates with effective and long-term protection.
"Furthermore, when a vaccine for this virus comes along, we must have a validated and quantitative assay for us to test
the vaccine. In the meantime, we need a validated test to identify individuals who make strong immune responses who
could donate antibodies to those who are severely affected. We could also isolate antibody genes from such strong
responders to reproduce their antibodies in the laboratory and use them as drugs for immunotherapy of critically ill
patients.
"Much work still needs to be done to optimise the sensitivity, validate the assay and put this onto a platform that can
be used readily. This work is critical and urgent and Universities, particularly UK universities, will be key. We in
Birmingham have the expertise required for this and will work with industry to do all that is required to produce an
effective test."
No conflict of interest declared.
Professor Wraith's comments come via the UK Science Media Centre.