COVID isolation: Are our immune systems out of practice?
The 2020/2021 influenza season was remarkable — remarkable for the low number of infections. It’s hardly surprising, given that the flu virus spreads via droplets, just like SARS-CoV-2, the virus that causes COVID-19.
And we’ve all learnt to reduce the risk of that over the past year-and-a-half: We’ve been wearing face masks, keeping a safe distance from people in public, washing our hands regularly, and disinfecting stuff. (Well, many people have, anyway.) That has helped slow the spread of COVID-19 as well as that of the common cold.
In a recent edition of its monthly influenza report, Germany’s Robert Koch Institute, the country’s federal center for disease control and prevention, confirmed that.
It said there had been no “measurable” wave of flu infections in Germany or in other European countries during the 2020/2021 flu season. (Ed.: links to German text)
The World Health Organization reported a similar trend in a recent Influenza Update (July 19, 2021).
Looking at its global figures, the WHO says that “despite continued or even increased testing for influenza in some countries, influenza activity remained at lower levels than expected for this time of the year.”
Infections reported less frequently
The same is true of other infections. The RKI reports a drop of 35% in infectious disease cases between March and August 2020. (Ed.: links to German text.)
The biggest drop was among respiratory infections — those that spread via a person’s airways, breathing and the like. Measles infections, for instance, were down by 85.5%. Whooping cough was down by 63.7%.
Even gastrointestinal infections were down: Rotavirus infections dropped by 83.3% and norovirus infections were down by 78.7%.
But the reasons for the drop in infections varies from virus to virus, say the experts.
Restrictions on in-person contacts and other hygiene regulations have played a part, especially among gastrointestinal infections.
However, it is just as conceivable to think that a number of infections have gone undetected with people avoiding unnecessary trips to the doctor during lockdown.
The RKI’s analysis suggests there was also a drop in the number of hospital bug infections. It says that may have something to do with a drop in the general number of patients when non-urgent operations got postponed.
Add to that the fact that hospitals have introduced stricter hygiene standards since the start of the pandemic, and that may have resulted in fewer infections overall.
There was also a drop in the number of sexually transmitted infections and those transmitted via the blood.
HIV infections dropped by 22.1%. But the RKI thinks that may have to do with restrictions that clinics and counseling centers have faced during the pandemic.
As a result, it’s possible that the number of unknown or unreported cases is very high.
RSV cases rise in children
In some parts of the world, the number of cases of respiratory syncytial virus (RSV) has gone up in children.
The US Centers for Disease Control and Prevention says RSV is a common respiratory virus that “usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults.”
The RKI’s assessment is similar. It says RSV can affect people of all ages, but that it most often affects infants.
RSV is highly infectious. It is transmitted when an infected person sneezes or coughs — the same as with SARS-CoV-2.
In March, there were a number of cases in Australia. In New Zealand, the number of cases have risen consistently since the end of May.
Meanwhile in Central Europe, where RSV cases tend to rise between November and April, that traditional “RSV season” was relatively quiet.
But cases are starting to present themselves now. France, Switzerland and the United Kingdom are reporting more and more RSV cases.
The Royal College of Emergency Medicine (RCEM) wrote in June that emergency centers in the UK were seeing a “dramatic rise in the number of young children — but it’s not COVID.”
RSV symptoms include runny nose, coughing, reduced appetite and fever. It can also develop into an acute bronchitis or lung infection. An RSV infection is one of the most common reasons for hospital admissions among infants and young children.
Germany’s RKI estimates a worldwide RSV incidence rate of 48.5 cases per 1,000 children in the first half of 2021, with 5.6 cases per 1,000 kids being severe.
Between 50 and 70% of kids get at least one RSV infection in their first year after birth. By the time kids turn two years of age, almost all of them have had a RSV infection.
Winter in June
Emergency admissions at UK hospitals are on the rise at the moment with cases of RSV — which usually happen in the winter — happening now, in the (northern hemisphere) summer.
It’s putting accident and emergency centers (AE) in the UK under a lot of extra pressure, reports the Royal College of Paediatrics and Child Health (RCPCH). They say worried parents have been bringing their kids to AE with the slightest fever. One emergency doctor described the situation as “winter in June.”
Small wonder. A lot of parents may have forgotten what to do when their kids get fever, or they may have never experienced it at all — especially if their kids were born during lockdown and they haven’t seen them sick very often.
So, the RCEM has published guidance to help parents with small children, because in many cases, they say, there’s no need to take your kids to AE.
“In most cases of mild fever, runny nose or cough, simple self-care measures such as taking paracetamol or ibuprofen can help, but in cases where parents are concerned, seeking medical assistance from a pharmacist, their GP or by calling 111 [Ed.: a medical help number provided by the UK’s National Health Service] is the appropriate first port of call,” writes the RCEM.
Disrupted balance
Back in March, German virologist Sandra Ciesek said we usually live in a natural “balance” with viruses but that that had been disrupted by the pandemic. Ciesek heads the Institute of Medical Virology at Frankfurt’s University Clinic.
Speaking on NDR’s Coronavirus Update podcast, Ciesek said kids had been totally cut or sealed off from viruses and other illnesses. (Ed.: links to German text.)
That happened when schools shut and face coverings became obligatory in public, or people limited their social contacts — they were cut off from the viruses that would normally confront them regularly.
Kids were protected against many common colds in lockdown. They now lack the antibodies to fight them off.
“It just shows how we usually co-exist with viruses. And it shows how artificial conditions, like limiting personal contacts, can influence [the spread of] viruses, and that rates of infection can get artificially moved from [one season to another],” said Ciesek in March.
Immune system out of practice?
Out of balance does not, however, mean out of practice. Pediatricians in Germany are reporting “a slight increase” in RSV infections, said Jakob Maske, spokesperson for the Professional Association of Pediatricians to the dpa news agency. “But we’re relatively relaxed about it.”
Maske suggests children are merely catching up with the infections that they would have had earlier had it not been for the corona pandemic and the lockdowns.
“RSV causes a common cold, you wouldn’t normally look for it as such. The associated risks are less than those associated with COVID-19 or flu,” he said.
In fact, says the pediatrician, “it’s normal to see kids getting these infections. Sure, we’ll see slight increases over the coming months. The main difficulty with a runny nose is telling the difference between COVID and a common cold.”
The immune system is not a muscle that needs training
It begs the question whether kids will have more severe infections after the COVID pandemic if their immune systems missed out “training” during winter lockdowns?
Carsten Watzl, the secretary general of the German Society for Immunology, says we may see more infections but not necessarily more severe ones.
Watzl says the immune system is not like a muscle that’s got weak during the pandemic.
He says our immune systems have had enough to do, even in lockdown, because germs don’t only get into our bodies through airways but also through things like food.
But it depends on the virus, says the immunologist. “The rhinovirus [Ed.: another common cold virus], for instance, keeps changing and always appears to the immune system as new. It’s got nothing to do with a lack of experience,” he says.
Strategy versus nature
After a while, it’s just your turn again. You’re going to get sick.
And because of the various lockdowns, says Watzl, more people will get sick now. We will, he says, probably see more common colds and RSV infections. But he doubts we will see more rhinovirus infections.
In an Autumn-Winter Strategy paper, the RKI warned that hospitals and emergency centers should prepare early for higher numbers of general infections. It cites respiratory viruses that did not circulate as much during the 2020/2021 season. Infections will include flu and — it goes without saying — SARS-CoV-2.
This article was translated from German.
Article source: https://www.dw.com/en/covid-isolation-are-our-immune-systems-out-of-practice/a-58733783?maca=en-rss-en-all-1573-rdf