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The Tripledemic and the Immune System

I kept meaning to write about one of the crises facing the medical system today, either the severe lack of mental healthcare professionals for crazy-stressed patients, the ongoing retirement of burned-out primary care doctors, or the shortage of decent nursing-homes for my elderly-dementia patients. But some other medical news always seems to take precedence. This month, the questions my family and friends brought up during the Thanksgiving get-togethers have mostly centered around the current epidemics.

Los Angeles is definitely going through the tripledemic of Covid-19, Flu, and RSV infections. Our hospital's pediatric ward and ICU have been filled with sick kids for months now. Then came the slow rise in Influenza A and B infections in our adult populations. Then the surge in Covid-19 cases across the board in the past 3-4 weeks.

Epidemiologists are attributing these 3 epidemics to a concept called "the immunity debt" which society has to pay for hunkering down and isolating for the past 3 years. The immunity debt is a concept applicable to society as a whole and not at the individual level.

Some people are mistakenly applying this concept of immunity debt to the individual level and think that because our immune system has not had to exercise and work at all for the past 3 years then those immune muscles are out of shape and not working very well when they do encounter infections. This theory, that the immune system gets weak if you don't expose your body to infections, does not actually hold water when you examine the current and all the epidemics that have killed millions throughout history. From smallpox to polio, from the bubonic plague in Europe to the syphilis spread in the Americas, it's the newness of the particular infection that can take a population down. Neither exposure to normal, routine infectious organisms nor to other deadly infectious organisms helped.

The Vietnamese have a delusional saying "o do song lau" meaning "live dirty live long". But over and over, people who live in filth and are exposed to environmental dirt, virus, bacteria, worms, and parasites invariably die an earlier death than those who are clean and avoid contact with those hundreds of organisms that can and do kill you. Just goes to show that not everything ancient people say are wise or smart.

If these organisms happen to be airborne, and there is no way to avoid them other than to live in a glass bubble or in a draconian lockdown society forever, then we have to train our immune system to repel these invaders. That is the whole point of vaccinations. To give our immune system a safe exposure to a similar-looking antigen so it can recognize the real thing and try to repel these invading forces when they break through our skin and mucus membranes.

In reality, the Covid-19 surge is totally expected with the loosening of masking and testing mandates. The flu comes around every year in the winter whenever it can spread, some years we have more deadly or virulent flu variants than others. Only the RSV epidemic is a result of lack of exposure to prior infections. RSV is one of the few childhood diseases that have no vaccines yet. Since the world population is growing at around 60 million a year. That's roughly 180 million kids who have been born into a pandemic-isolation world where they have had zero exposure to this particular virus until now.

Prior to the pandemic, about 1 in 50 children from 0-5 years old will be hospitalized every year due to this infection, scattered over the entire year as the virus circulates freely in the population. About 60-80% of bronchiolitis hospitalizations are due to RSV. Now all of those children who have not been exposed in the past 1000 days are getting exposed at the same time due to the re-opening, and the same percentage of them will end up in the hospital as usual, making for a traffic jam in the pediatric wards everywhere.

The immune system really is a fascinating and complicated set of cells in the body. In super-simplistic terms, there are cells to fight off bacteria (neutrophils), cells to fight off viruses (lymphocytes), cells to fight off parasites (eosinophils), cells to fight off fungus (monocytes), and cells to get rid of cancer (natural killer cells). Of course, there are multiple subtypes, multiple functions, and hundreds of interactions.

Although the immune system is an awesome and powerful thing, it can be weakened by many things in our lives. The most common culprits are chronic stress, smoking, drinking, high blood sugar, infections, and lack of sleep, lack of nutrition.

When we have a low immune system, we can catch infections easily and take longer to fight them off or sometimes fail to fight them at all. In addition, viruses and bacteria that are known to hide inside our cells and lie dormant from previous infections can break out when our immune system is low. Tuberculosis is the classic bacteria to do this, especially in malnourished people. HPV or viral warts can break out when people go through chronic stress. Herpes simplex breaks out when we have a cold or don't get enough sleep. Shingles break out along the nerve cells that it hides in when we're weak or have a sunburn. Cytomegalo virus, pneumocystis fungus, toxoplasma parasite, tuberculosis bacteria, and Kaposi sarcoma cancer can all attack AIDS patients with low immune cells.

While some people believe in taking elderberries, echinacea, garlic ginseng, or reishi mushroom to improve their immune system, I think the most important thing you can do for your body as a whole, and immune system in particular, is eat a well-rounded diet, get 6- 8 hours of sleep a night, take some time to meditate, play, read, anything to reduce stress, and care for your mental health. Then you should be able to fight off most of life's pesky infections. But for the more deadly ones, go get vaccinated if you can. Get those immune cells some practice exercise before they have to face off with the real opponent.

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