By Kenji Irie, M.D.
It is now the end of July 2020 and the number of people infected by Coronavirus (COVID-19) keeps rising in California. Yet, the government is slow to reinstate the restrictions. I am concerned. Thus I have decided to write another article on the virus.
In my previous article, “Coronavirus Prevention for Seniors,” I missed 3 important issues, which I would like to discuss here.
1) Why are seniors susceptible to COVID-19 infection?
I searched for explanations for the problem; however, I did not find any in literature or on the internet. So, I am offering my thoughts here. In reviewing other groups of people who are also known to be vulnerable to the viral infection, I was given a hint. Besides seniors, people
susceptible to the infection include diabetic persons, those with chronic illnesses (such as chronic heart failure, kidney failure, lung diseases), and those undergoing cancer chemotherapy. Within the body of a person with diabetes (diabetes mellitus type 2), fat tends to precipitate to the walls of blood vessels, making blood circulation sluggish. As a result, metabolism of the whole body decreases. Such immune organs as lymph nodes, white blood cells, and spleen, etc. are affected. Because of lowered immune functions, diabetic people are known to have higher rate of infections in general, compared with non-diabetics. On the other hand, lack of exercise causes accumulation of sugar and fat in the body, which
is a major triggering factor in inducing diabetes. If a diabetic person develops such complications as kidney and heart diseases, small blood vessel diseases and so on, it becomes difficult for him/her to exercise. Although there are exceptions, people with diabetes as a whole have a tendency for insufficient exercise. It is widely known that exercise
stimulates the muscles to produce Endorphin, a hormone, and Endorphin in turn accelerates the activities of the immune organs. This means that lack of exercise can make people’s immune activities weaker. In other words, lowered metabolism and insufficient exercise can be summarized as the reason for the diabetic person’s susceptibility to COVID-19.
A characteristic of people with chronic illnesses such as heart failure or various lung diseases is their development of breathing difficulty even while doing light exercises. As a result, they tend to avoid exercise and produce only small amounts of Endorphin, which causes low activities of the immune organs. Agents for cancer chemotherapy suppress functions of all normal cells, which include the immune cells. With lowered immune functions, people with chronic illnesses or those undergoing chemotherapy are also susceptible to COVID-19. In reviewing these vulnerable groups, one notices a common element and that is the decreased activities of the immune organs resulting in lowered productivity of the antibodies to fight the virus. The process of aging has some similarities. Various bodily functions slow down and this includes metabolism. Lowered metabolism gives us not only the undesirable wrinkles of the skin but also weak immune reactions. Exercising also tends to slow down with age. As a result, we become easy targets of all infectious organisms including COVID-19. Once infected, seniors are apt to fall into critical conditions. However, elders should not to be discouraged. It is important to think of ways to fight back. One is to do more exercise. Just like the younger generations, it is possible for seniors through exercising to allow the muscles to produce more Endorphin. Endorphin stimulates the immune cells and helps our body to fight off infections, including COVID-19. I realize that there are people who become easily out of breath by exercising due to chronic illnesses. Recommendation is for these individuals to do very light exercises such as slow walking, lifting low weight dumbbells, stretching joints & muscles, or as the Japanese do, “radio” exercises. Oxygen inhalation may be necessary during the exercise.
2) Care for an infected family member at home
People in the following categories are to be cared for at home:
a. People with only mild symptoms (those with severe symptoms need to be hospitalized).
b. Those showing COVID-19 symptoms, but have tested negative on PCR study.
c. Those who have tested PCR positive, but show no symptoms. I would like to itemize the care issues here.
* A room should be assigned & prepared for the infected family member. If no room is available, the area around the infected individual’s bed should be enclosed using curtains to create a semi-isolated space.
* Family members vulnerable to the infection, as described above, should not take the role of caring for the infected.
* Caregiver is to wear a mask, rubber gloves, a pair of goggles, and a cap (shower caps are appropriate & convenient) just before entering the room or the designated space. Immediately after coming out of the room, caregiver should remove the protective gears and either discard or boil them. Caregiver should wash hands with soap or sanitize them with rubbing alcohol before and after coming out.
* It is a good idea to wear a raincoat, a lab coat, or a kitchen overall (“Kappoh-gi”in Japanese) for protection. It should be hung inside of the door of the isolation room before the caregiver goes out. If it is taken outside of the room, overall should be sanitized by placing it in boiling water.
* As a rule, the infected person should not go out of the room.
* The isolation room should be ventilated as frequently as possible.
* Items touched by the infected individual need to be sanitized by rubbing alcohol (70%) often, since the virus attached to hard surfaces is infectious for approximately 12 hours. These items include doorknobs, tap water faucets, toilet handles, bed frames, back of chairs, and nebulizer parts (metallic or plastic), etc.
* Dishes, utensils, towels, clothes, sheets, etc. used by the infected person should not be shared by other family members until they are sanitized by detergent, soap, or boiling water. COVID-19 has been found not only in secretions from the respiratory tracts but also in stools.
* Tissues or paper napkins used by the infected individual for blowing the nose or wiping the phlegm away from the mouth need to be placed in plastic bags. Bags should be tightly closed and discarded into garbage cans. The individual who assumes this role should immediately wash hands.
* Follow guidelines given by the infected person’s doctor in administering medications and providing nutrients/vitamins.
3) BCG effect
Eight months have passed since the first outbreak of COVID-19 in China. And nearly 4 months have elapsed since WHO declared the pandemic. In the USA, the number of people infected by the virus has surpassed 4 million, and deaths are more than 150 thousand. On the other hand, the number of infected people in all Asian countries including Japan is reportedly less than 1/10 of the US number. Deaths per one million populations are less than 1/30 of the US. What is the reason for the huge difference? There are various theories being discussed. One of them is the BCG effect. One of the main proponents of the BCG theory is Dr. Yoshimoto Katsura, an immunologist and a former professor of Kyoto University, Japan. I have read his comment online ( 4/29/2020 ) on the BCG effect. BCG stands for Bacillus Calmett-Guerin, and is a substance obtained by killing the TB bacteria (bacillus) halfway. BCG does not possess infectious capability but it does possess other biological features. In Asian countries where TB is still a serious threat, BCG is widely used for vaccinating citizens
to prevent TB. This is not the case in Europe or in the USA. According to Dr. Katsura, there are immune cells called macrophages in the human body. The role of the macrophages is to send messages to all other immune cells to “fight back!” This occurs soon after such microorganisms as bacteria or viruses enter the human body from the outside. BCG has been known for a long time to accelerate the function of the macrophages (called “Adjuvant effect of BCG” in immunology). Since most citizens in Asia receive the BCG vaccination, their macrophage activities are considered to be generally high. Consequently, their COVID-19 infection rate and death rate may be much lower than those of Euro-American nations. Dr. Katsura also points out that asymptomatic infections of TB in these countries are able to give the adjuvant effect to macrophages just like BCG and may help to reduce the infection and death rates caused by COVID-19. I am not certain if the BCG theory can explain all of the huge differences; however, I believe it explains at least a part of the difference.
Hiroyuki Ishi was a classmate of mine in elementary school. He loved watching insects, small animals, and various plants in the relatively large schoolyard. He eventually became a reporter for the science section of Asahi Shinbun Newspaper. Upon retirement, he decided to write books focused on global environmental issues. And he did it at an amazing pace of one book per year. Now he is a popular nonfiction writer in Japan. One of his books entitled, “World History of Infectious Diseases”(Kadokawa Sophia Series 2018) precisely predicted the current COVD-19 pandemic. Because of his extraordinary foresight, the book was a top seller on Amazon’s nonfiction list in Japan this year. On 2/20/2020, he was interviewed by Kadokawa Book Company, the publisher, and in it, he stated, “the battles between human beings and viruses will continue FOREVER.” This is truly a dreadful prediction. It follows then that we, seniors must make up our minds about maintaining a daily exercise routine to keep
our immune resistance at a HIGH LEVEL!