Humans have a habit of boasting about their power but a microorganism, COVID-19 has forced mankind to kneel down. This novel coronavirus wakeup call could be a sign of impending catastrophe.
We share the same environment while living with our family and in our localities, but usually only some of us are more prone or gets these infections more commonly than others. Have you ever thought why this happens? The COVID-19 pandemic has reemphasised that in addition to hand washing, isolation, social distancing, there is something else which matters more than other things to prevent any infection– our immunity.
The immune system is a natural defence system our body possesses against any bacteria, virus, parasite, fungi and any other environmental toxins with potential to make us ill. The environment is full of these pathogenic invaders. Whenever our immune system is weak, these bacterium and virus take over the defence system of our body. In general, low count of haemoglobin, total protein and T lymphocyte count are the common markers of low immunity. In one of the most comprehensive analysis of immune function performed till date, published in the journal Cell in 2015 revealed that our daily habits and environment like the history of past infection, shapes our body’s defence and immunity more than the DNA passed down by our parents. An effective and efficient immune system is central to the host’s defence against infectious diseases. The immune system has the capacity to respond to millions of antigens. Our immune system is of two types; the innate or natural and the acquired or adaptive. It is known that individuals with defective immune response are more susceptible to develop infection and are more likely to suffer from infectious morbidity, mortality and improving the immunity reverses and decreases these two parameters.
Environmental, scientific and technological advancement has shown less effect on the COVID-19 infection as it also emerged in countries which are viewed as developed. USA, which is one of the most developed countries has in fact got the most number of infected patients and the highest mortality among other countries of the world. It seems that personal hygiene and public sanitation were not very effective factors to prevent the emergence and spread of the virus in the nations which have the highest standards of cleanliness.
As our age advances, the immunity of the body decreases to even fight against a less virulent virus or bacteria which can give rise to an illness. It has been seen in the COVID-19 pandemic that the communities within the affected population with a compromised immunity are at high risk of developing the infection and also have a high mortality. Most of the people, who died due to the current pandemic were above 60 -70 years and had co-morbidities like diabetes, respiratory and kidney diseases.
There are various ways to strengthen the immune system like good diet, antibody infusion or vaccination. The idea of vaccination is to give a mild controlled infection in the body which produces antibody to that antigen. Gene therapy and bone marrow transplantation are other costly ways to tackle weak immunity in selected cases. Convalescent plasma therapy has been a recent technique which has been used to improve the immediate urgent need of antibodies against a particular infection or antigen. According to an article in American journal proceeding of National Academy of Sciences, it was found that 10 patients in China who were critically ill began to show significant improvement after convalescent plasma therapy in which plasma taken from people who recovered from COVID-19 was processed and centrifuged. This convalescent plasma therapy is under trial and also approved by ICMR in selected COVID-19 infections in our country as well.
The means to enhance the immunity mentioned earlier are cost ineffective and cannot be practiced at the large scale in masses. Planned and well enforced steps need to be taken to enhance the general immunity by diet and nutrition in the entire country which will be cheaper and have long lasting effects like the midday meal scheme implemented in 1995 for school children.
Individually, the first step should be to change our lifestyle which should include consumption of more fresh fruits and seasonal green leafy vegetables. We should also try to do more physical work. The third step is to reduce smoking and alcohol consumption to a minimum level. The last and important thing is to get a good eight hours sleep which also reduces and minimises our stress level. Scientific studies have shown that our immune system is made, not born. The development, maintenance and optimal function of immunity are dependent on adequate nutrition. Immune response can be improved only by nutrition. Our health deteriorates if we become malnourished. Malnutrition is common in our country and is usually of two types- quantitative and qualitative. In quantitative, individuals lack adequate calories in their diet and in other one they have enough calories usually from junk food which lacks enough quantity of all desired nutrients. Proteins are the building blocks to improve and enhance our immunity. Pulses are the common source of protein. Eggs are the best source of high quality protein, which is almost 100% absorbable by the gut. Micro nutrient malnutrition is very common in our country especially among the poor although it is also seen in affluent society. It is also common in developed countries particularly in the geriatric age group due to lack of appetite and mal-absorption of food. It is known that green vegetables and the fresh fruits are the main and the rich sources of micronutrients but people prefer to avoid them as they usually produce gaseous distension and bloating. The micronutrients which include minerals and vitamins play a very important role in maintaining good health and particularly help in developing good immunity. They are iron, zinc, selenium, copper and vitamins like B6, B12, folic acid, C, D, and E.
There are nearly 30 minerals and a few vitamins which our body cannot synthesise. These micronutrients and vitamins are abundant in nuts, seeds, green vegetables and fresh fruits and can be found in citrus fruits, red bell pepper, broccoli, garlic, ginger, spinach, carrot, yogurt, almonds, walnut, turmeric, green tea, banana, papaya, kiwi, poultry, sunflower seeds, shellfish, and cinnamon.
Population ageing is a global phenomenon. According to 2019 UN report, 9% of the total world population is above 65 years of age. People are now living longer but not living healthier. It is estimated that in India, almost 30 million elderly are above 80 years and require some sort of medical or physical assistance. Health and pharmacy industry are working to make humans immortal. The goal should rather be to improve quality of life so that humans can also live comfortably and independently for rest of their life as other animals are living.
(The authors are orthopaedic surgeons based in Dehradun)
Friday, 08 May 2020 | Dr. Gaurav Sanjay & Dr BKS Sanjay
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