Organ transplant recipients vulnerable to COVID-19 even after vaccination

Although two doses of a COVID-19 vaccine confer some protection for people who have received solid organ transplants, it's still not enough to enable them to dispense with masks, physical distancing and other safety measures, according to a study. This is a follow-up study to an earlier one in which the researchers reported that only 17 per cent of the participating transplant recipients produced sufficient antibodies after just one dose of a two-dose COVID-19 vaccine regimen.

"While there was an increase in those with detectable antibodies after the second shot, the number of transplant recipients in our second study whose antibody levels reached high enough levels to ward off infection was still well below than in people with healthy immune systems," said study lead author Brian Boyarsky from the Johns Hopkins University School of Medicine in the US.

"Based on our findings, we recommend that transplant recipients and other immunocompromised patients continue to practice strict COVID-19 safety precautions, even after vaccination," Boyarsky said.

The researchers noted that people who receive solid organ transplants, such as hearts, lungs and kidneys, often must take drugs to suppress their immune systems and prevent rejection.

Such regimens may interfere with a transplant recipient's ability to make antibodies to foreign substances, including the protective ones produced in response to vaccines, they said.

The latest study, published in the Journal of the American Medical Association (JAMA), evaluated this immunogenic response following the second dose of either of the two mRNA vaccines -- made by Moderna and Pfizer-BioNTech -- for 658 transplant recipients, none of whom had a prior diagnosis of COVID-19.

The participants completed their two-dose regimen between December 16, 2020, and March 13, 2021.

The researchers found that only 98 of the 658 study participants -- 15 per cent -- had detectable antibodies to SARS-CoV-2 at 21 days after the first vaccine dose.

This was comparable to the 17 per cent reported in the March study looking at the immune response after only one vaccine dose.

At 29 days following the second dose, the number of participants with detectable antibodies rose to 357 out of 658 -- 54 per cent, the researchers said.

After both vaccine doses were administered, 301 out of 658 participants -- 46 per cent -- had no detectable antibody at all while 259 -- 39 per cent -- only produced antibodies after the second shot, they said.

The researchers also found that among the participants, the most likely to develop an antibody response were younger, did not take immunosuppressive regimens including anti-metabolite drugs and received the Moderna vaccine.

These were similar to the associations seen in the March single-dose study, they said.

"Given these observations, transplant recipients should not assume that two vaccine doses guarantee sufficient immunity against SARS-CoV-2 any more than it did after just one dose," said study co-author Dorry Segev, from the Johns Hopkins University School of Medicine.

 

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Ultrasound has potential to damage coronavirus

Coronavirus may be vulnerable to ultrasound vibrations, within the frequencies used in medical diagnostic imaging, said researchers.

Through computer simulations, the team modelled the virus' mechanical response to vibrations across a range of ultrasound frequencies and found that vibrations between 25 and 100 megahertz triggered the virus' shell and spikes to collapse and start to rupture within a fraction of a millisecond.

This effect was seen in simulations of the virus in air and in water, said the researchers, including Tomasz Wierzbicki from MIT.

"We've proven that under ultrasound excitation the coronavirus shell and spikes will vibrate, and the amplitude of that vibration will be very large, producing strains that could break certain parts of the virus, doing visible damage to the outer shell and possibly invisible damage to the RNA inside," said Wierzbicki.

The coronavirus structure is an all-too-familiar image, with its densely packed surface receptors resembling a thorny crown, the team said.

These spike-like proteins latch onto healthy cells and trigger the invasion of viral RNA. While the virus geometry and infection strategy is generally understood, little is known about its physical integrity.

For the study, published in the Journal of the Mechanics and Physics of Solids, the team introduced acoustic vibrations into the simulations and observed how the vibrations rippled through the virus structure across a range of ultrasound frequencies.

The team started with vibrations of 100 megahertz, or 100 million cycles per second, which they estimated would be the shell's natural vibrating frequency, based on what's known of the virus's physical properties.

When they exposed the virus to 100 MHz ultrasound excitations, the virus's natural vibrations were initially undetectable. But within a fraction of a millisecond the external vibrations, resonating with the frequency of the virus' natural oscillations, caused the shell and spikes to buckle inward, similar to a ball that dimples as it bounces off the ground.

As the researchers increased the amplitude, or intensity, of the vibrations, the shell could fracture -- an acoustic phenomenon known as resonance that also explains how opera singers can crack a wineglass if they sing at just the right pitch and volume.

At lower frequencies of 25 MHz and 50 MHz, the virus buckled and fractured even faster, both in simulated environments of air, and of water that is similar in density to fluids in the body.

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7 Interesting Facts About The Human Immune System

The human body is an absolute marvel of science and biology, with every limb, bone, tissue and cell having their own important functions. One of the most important systems in the body has to be the immune system. Our immunity is what keeps us alive in a world teeming with bacteria and germs. If you've ever seen the movie "The Boy In The Plastic Bubble" (1976), you might gain some understanding of what the world can be like if you have no immune system.

Our knowledge about this particular system has revolutionized medicine, propelling the creation of most vaccinations, that have drastically increased the average human life span. To give you a little bit more insight into this incredible system of warriors and protectors, here are 7 facts you may not have known about your immune system.
 
1. Laughter can really be the best medicine
Studies have shown the general positive effects that laughter can have on the body. Laughter (and enjoyment in general) can increase the production of dopamine, serotonin and other feel-good hormones released by the brain, which can drastically reduce stress.

According to a study by Dr. Stephen Sinatra, laughter can also boost your immune system by increasing the cytotoxicity (which is basically the ability of one type of cell to foreign cells) of NK cells (natural killer cells). Natural Killer Cells are the type of white blood cells that can actually differentiate between infected or cancerous cells and normal ones.

They can avoid the latter and wipe out only the former in a much more effective way.
 
2. White blood cells are the 1%
White blood cells, also called Leukocytes, are the knights of the human body, fighting off harmful bacteria and keeping your body free of infections and viruses. It is one of the most important components of the human body. So one would think that the bloodstream is chock-full of these heroes, but in reality, they only make up 1% of the cells in your blood.

In this case, though, the 1% is pretty large, with up to 10,000 white blood cells in every microlitre (one-millionth of a liter) of blood. That counts for a lot when you consider the fact that there are 5 liters of blood in the human body. These cells are always on the move in the bloodstream, hunting down possible invaders, anywhere they might be.

3. Cows revolutionized our immunity
People first began experimenting with inoculation in the 1700's by introducing milder, but still deadly elements of the smallpox virus taken from previously inoculated patients, so the immune system could develop a resistance to the virus. Though this method was quite effective, it still resulted in many deaths.

It was eventually discovered that dairymaids had developed a stronger immunity to smallpox than most people when they had been previously exposed to cowpox, a disease with a lower fatality rate than Variolation (which is what the method of inoculation for smallpox, also known as Variola, was called). Using this knowledge and the cowpox virus, Edward Jenner pioneered a smallpox vaccine in 1796.
 
4. There is such a thing as too clean
The common belief is that the cleaner our environment is, the safer we are. But this is a misconception bred and borne by us. In truth, an extremely clean environment can halt the development of your immune system.

Your immune system ends up not getting exposed to many of the foreign particles that usually help it develop anti-bodies and become stronger. This can be especially problematic for children, whose 
immune systems require exposure to develop and grow.
 
5. Allergies are just the immune system’s mistakes
Everybody makes mistakes and your immune system is no different. Most of the reactions your body has to substances you're allergic to arise because the immune system gets confused and mistakenly takes the foreign substance, be it pollen, peanuts or dust, to be a dangerous foreign particle.

So it reacts the way it's built to react to anything that it has understood to be harmful and attacks the substance in your body, doing some damage to your body in the process. This causes many of the symptoms we experience, from itchiness to swelling in different areas.
 
6. Women are more vulnerable to immune system attacks
Autoimmune diseases, like rheumatoid arthritis, basically occur when the immune system gets all turned up. It becomes extra defensive and is unable to differentiate harmful foreign bodies from healthy cells and tissues in the body. So it begins to attack perfectly healthy cells, which can cause inflammation, severe pain and numerous other serious health problems. But as it turns out, autoimmune diseases are somewhat selective.

While less than 10% of the population in the USA suffer from auto-immune diseases, an article published in 2008 in the American Journal of Pathology observed that nearly a whopping 80% of those suffering from autoimmune diseases were women. Women can be especially vulnerable to these diseases during ovulation, pregnancy and immediately after giving birth.

7. Stress, sleep, sunlight and your immune system
Stress is not good for your immune system. Too much stress may result in your immune system getting suppressed, which directly increases the likelihood of you catching a virus.

Lack of sleep similarly affects your immune system, reducing the number of natural killer cells in your body, and can even reduce the effects of vaccinations as a result, as observed in a 2012 study.

Sunlight can have mixed effects. Exposure to sunlight can increase the Vitamin D in your body, as well as the production of serotonin, which keeps you happy and can help reduce stress. But high levels of exposure to ultraviolet radiation and sunlight can result in the suppression of the immune system, and thereby an increased vulnerability to infections and viruses. As with most things, a little is good for you, a lot can be bad. 

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WHO Sets 6 Conditions For Ending A Coronavirus Lockdown

For the billions of people now living under some form of stay-at-home or lockdown orders, experts from the World Health Organization have new guidance: We should be ready to "change our behaviors for the foreseeable future," they say, as the agency updates its advice on when to lift COVID-19 lockdown orders.

The question of when to ease shutdowns is a hot topic, as economic output is stalled in many countries — including the U.S., now the epicenter of the global pandemic.

"One of the main things we've learned in the past months about COVID-19 is that the faster all cases are found, tested, isolated & care for, the harder we make it for the virus to spread," said WHO Direct0r-General Tedros Adhanom Ghebreyesus via Twitter as the guideline was released. "This principle will save lives & mitigate the economic impact of the pandemic."

The coronavirus has killed tens of thousands of people. It has also reshaped society and disrupted daily life for people around the world – including 1.4 billion children whose educations are now derailed by shutdowns, WHO says. The pandemic has triggered massive losses for big companies and small businesses, and forced millions of people out of work.

While full national lockdowns remain uncommon, at least 82 countries have some form of lockdown in place, according to UNICEF.

The global economy is now predicted to shrink by 3% this year, the International Monetary Fund says in its most recent analysis. That includes a contraction of nearly 6% for the U.S. economy.
Despite all the personal and economic pain the coronavirus has caused, WHO officials say that in many places, it's too soon to get back to normal. And because any premature attempts to restart economies could trigger secondary peaks in COVID-19 cases, they warn that the process must be deliberate and widely coordinated.

"You can't replace lockdown with nothing," Dr. Mike Ryan, executive director of WHO's emergencies program, said at a recent briefing. Stressing the importance of a well-informed and committed population, he added, "We are going to have to change our behaviors for the foreseeable future."

Any government that wants to start lifting restrictions, said Tedros of WHO, must first meet six conditions:

1. Disease transmission is under control

2. Health systems are able to "detect, test, isolate and treat every case and trace every contact"

3. Hot spot risks are minimized in vulnerable places, such as nursing homes

4. Schools, workplaces and other essential places have established preventive measures

5. The risk of importing new cases "can be managed"

6. Communities are fully educated, engaged and empowered to live under a new normal

The worldwide number of COVID-19 cases is quickly approaching the 2 million mark, including more than 120,000 people who have died, according to a COVID-19 dashboard created by Johns Hopkins University's Whiting School of Engineering.

The number of new cases continues to rise sharply in the U.S., where disagreements over the potential restarting of economies recently prompted at least 10 states to band together in regional coalitions. The governors of those states say they — not President Trump or the federal government — will determine when to resume normal activities, based on health statistics and science.

Even in instances where governments can lift some lockdown conditions, Ryan said, "Health workers are going to have to continue to have protective equipment and we're going to have to continue to have intensive care beds on standby, because as we come out of these lockdown situations, we may see a jump back up in cases."

The goal is to taper restrictions so governments – in communities, cities and nations — can avoid a cycle of new COVID-19 outbreaks.

"We don't want to lurch from lockdown to nothing to lockdown to nothing," Ryan said. "We need to have a much more stable exit strategy that allows us to move carefully and persistently away from lockdown."

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