A look at the role that the immune system is playing in the fight against COVID-19.
As millions of Americans isolate themselves to avoid infection, scientists are working urgently to develop the vaccine, antiviral, or magic pill that will contain the coronavirus. If only there were an antivirus program designed to protect the human operating system. Well, actually, we do have one. It’s not made by McAfee or Microsoft; rather, it’s our immune system.
In this week’s WhoWhatWhy podcast, we talk with Pulitzer Prize–winning technology journalist and mystery writer Matt Richtel, whose book about the immune system, An Elegant Defense, details our cellular police force.
Richtel lays out how the immune system not only protects us, but, if it kicks into place too quickly, can also kill us. In fact, many deaths from both influenza and coronavirus are the result of an extreme immune response. He explains why a balanced immune system is good, and why a boosted immune system is bad.
Richtel makes clear that if we can better understand the immune system, we can not only reshape our response to the virus but also develop better treatments for allergies, autoimmune conditions, cancer, and the myriad diseases related to aging.
He reminds us that in labs today, all across the world, scientists are developing treatments for cancer and many other diseases utilizing immunotherapy, which harnesses the power of the body’s own immune system.
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| Jeff Schechtman: | Welcome to the WhoWhatWhy podcast. I’m your host, Jeff Schechtman.
Seldom if ever has an entire world collectively and in sync turned its lonely eyes on health, and what makes the human body operate the way it does. Based on the volume of information and stories unleashed each day, we could be on the verge of minting thousands of new cellular biologists within months. |
| Jeff Schechtman: | From where I sit in the shadow of the Silicon Valley, we can’t help but wonder if only we could buy an antivirus program to take care of the human operating system. The irony is that we have that system. It’s not produced by McAfee or Microsoft, rather, it’s our complex immune system. It impacts the virus stalking the world today, but it also impacts every other aspect of the human body. |
| Jeff Schechtman: | To understand it is to understand aging, cancer, the mind-body connection. To harness it, to manipulate it, is the medical Holy grail of our moment, just as the discovery of penicillin and its class of antibiotics saved millions and truly changed the world. |
| Jeff Schechtman: | And just as we look to a vaccine and antivirals to save us now, the fact is that immunotherapy may not only save us in this moment but may be the key to future generations not having to face what we’re dealing with today. To help us better understand this, I’m joined by Pulitzer prize winning journalist Matt Richtel. |
| Jeff Schechtman: | Matt has written extensively about the immune system in his book, An Elegant Defense, and it is my pleasure to welcome him here to the WhoWhatWhy podcast. Matt, thanks so much for joining us. |
| Matt Richtel: | Hi Jeff, how are you? |
| Jeff Schechtman: | Well, it’s great to have you here, and to talk about this subject, which I think is powerfully on everyone’s mind these days. Talk a little bit, as someone that has looked at this, has studied this, we’ve talked about it when the book first came out, and really understands how the immune system works. How are you looking at the current crisis through the lens of what you’ve come to understand? |
| Matt Richtel: | Yeah. Jeff, I just want to say thank you for so eloquently putting that question because as you, before you got to the word “lens,” I was thinking to myself, I’m thinking about this through the lens of the immune system, and it’s, once you begin to understand how it works, it’s almost impossible not to. |
| Matt Richtel: | So I guess, let me start with, almost first principles here, before I get to the immune system. Have you heard this called the novel coronavirus? The word, the first thing that comes to mind for me is the word “novel.” And the reason that is so significant is, our immune system gets trained, and must be trained. And when it comes across something novel, it is momentarily helpless. |
| Matt Richtel: | I don’t mean ultimately helpless, but it finds itself without any precision tools. What is interesting about this, to go back one step further is, have you heard that this likely came from an animal mixing, essentially its DNA, with human DNA? |
| Jeff Schechtman: | Right, I mean we’ve heard everything from pigs to bats, as these stories have evolved. |
| Matt Richtel: | As these stories evolved, and I, let’s just say bats for a second, because it’s what I’ve heard more so, but acknowledge that we don’t really know. The relevancy of that, or the relevance of that, is that you basically wind up having a virus that mutates. And when it mutates in an animal, it mutates just enough to become viable inside of humans. |
| Matt Richtel: | But by virtue of it coming from animals, it presents the human immune system with something it has not seen before. The immune system is built upon training to fight things, so that when it sees them, it is prepared. It’s hard to prepare for something that came from, if you will, an alien species. |
| Jeff Schechtman: | As this evolves, as the immune system begins to deal with this, talk a little bit about how the immune system sees it, and one of the things that you’ve written about so elegantly, is the idea that the immune system is this carefully balanced mechanism, that if it doesn’t fight enough, it’s a problem. But if it fights too much, it’s also a problem. |
| Matt Richtel: | Yup, absolutely. And that will come into play later, as people are dying. So to step back, when I began, I really had a lot of misconceptions about the immune system. And one of them was that the immune system is this vicious killer that’s taking on every alien or foreign organism around us. |
| Matt Richtel: | And as we’ve discussed, Jeff, on your body, on your microphone, on the headset I’m wearing to speak to you, and the radios, or Internet devices where people are listening, there are bacteria, virus, parasites, most of them would do you no harm. And so, one of the most important things to understand about the immune system broadly before I speak to how it attacks this virus and recognizes it, is that the immune system doesn’t go after every single thing and try to destroy it. |
| Matt Richtel: | What it tries to do is, is not fight with those things that would do us no harm, and attack things that would do us harm. So how does it attack those that would do us harm? When this virus comes into our bodies, presumably, through the inhalation, or touching, and touching your face, through the contact of someone close to you, and a sneeze or a cough, the first thing that your body does is send its first immune system. It’s called the innate immune system, and it does a generic response. |
| Matt Richtel: | It’s like sending your first responders, fire and police, and I would liken it to an EMT. You know how an EMT stabilizes you in the ambulance? But ultimately you may need a surgeon or a specialist. And that is the second immune system, it’s called the adaptive immune system. And this is really the central piece of the conversation about why the novel coronavirus is so challenging. |
| Matt Richtel: | That adaptive piece is built on precision fighters that need to build factories. And in the case of the novel coronavirus, if we’ve never seen it before, your body goes through a process of searching around inside your lymph nodes for the precision fighter that can fight this disease, and then building, replicating copies of it. That takes time. |
| Matt Richtel: | If you’ve never seen it before, it takes even more time. And so, there are some diseases so dangerous to us, that by the time the adaptive immune system gets up and running, it’s too late. |
| Jeff Schechtman: | And this is in part, the sort of cutting edge of all this is, that this whole idea of the microbiome, and what it is that we’ve experienced in the past, what we’ve been exposed to. |
| Matt Richtel: | Yes. And this, it’s hard to be exposed to something that the human condition hasn’t seen before. Now, remember, I said that sometimes the immune system can get out of… a little bit out of control. You want to keep it balanced. One of the problems that crops up, and we’re seeing this, we think, particularly in older people, an immune system is not… Well, it may not be well calibrated to deal with something it hasn’t seen before. |
| Matt Richtel: | And in some cases, in particular, in older folks, it looks like the immune system can get a little bit out of hand, a little out of balance. Here’s a startling piece of trivia I learned. When people die in the ICU, presumably of pneumonia or other lung-related diseases, it’s not the disease that is killing them. It is often the flooding of the lungs with immune cells, and so, some of what we appear to be seeing in ICUs is too much immune response. |
| Matt Richtel: | One way to treat that is with steroids that dull the immune response. The other thing that we’re trying to do, and it goes to why we are all inside right now, is we put people on a ventilator, or in more extreme cases, a device called an ECMO, that helps people breathe, so that the immune system can first fight, and secondly, be held intact, so it doesn’t itself flood the lungs. |
| Matt Richtel: | And we hope to get through that period. That’s why we need to preserve these machines, so they help us breathe through this period, when the immune system is trying to calculate the proper response and not overrespond. |
| Jeff Schechtman: | Talk about that, because I think it’s one of the most interesting aspects of this, is that so many of the people that don’t make it through this, it is because of the overresponse to the immune system, as you say, because of the flooding of the lungs. |
| Matt Richtel: | Yes. So I want to concede to you guys, that we are very early on in the research, and it sounds to me, from the bits and pieces I’ve heard, and I suppose I’m following it more closely than many, but they’re still only bits and pieces right now, that in some cases we are absolutely seeing a kind of cascade of immune cells. |
| Matt Richtel: | And there’s a term for this, once I say it, you may begin to recognize it in the news, or see it in scientific articles. It’s called a cytokine storm. |
| Matt Richtel: | So, the immune, your body has all these signalers for the immune system. They’re molecules that send off all kinds of nuanced signals, but on the highest level, beneath all the nuance, or above all the nuance, the 30,000 foot view, is a bunch of signalers that say, either, “Attack,” or “Withdraw,” or, “Pause.” |
| Matt Richtel: | And a cytokine storm, a cytokine is the name for these signalers. A storm of them means, you get a whole bunch of them calling out, “Help, help, help, help, help,” and they rush to the scene. Curiously, sometimes when your immune system is already there, it may start signaling like crazy, because it doesn’t know what to do with all the muck, all the cells that are there, the detritus of other immune cells, and virus, and you wind up getting a mass of these cells. |
| Matt Richtel: | It sounds like from what I’ve read, that there can be, that there have been many instances of cytokine storms. And so powerful is the immune system, Jeff, that at that moment, it becomes much more dangerous than the virus itself. Make no mistake. It’s the virus that is causing this kind of cataclysmic cascade, but it is the immune system itself that has run amok. |
| Matt Richtel: | Why in older people? Well, I’m not sure we totally know that, but there are a couple of possibilities. One is that the immune system at first feels overwhelmed, because it is worn down in older folks, like any system, and then begins to kind of overreact in a way to the fact that it’s been overwhelmed. But another that is just as likely, to me, having looked at this, is that the immune system loses balance over the years. |
| Jeff Schechtman: | And I think people can understand this. By the way, maybe they understand allergies, or other kind of autoimmune diseases, where an allergic reaction is essentially an overreaction of the immune system. |
| Matt Richtel: | Yes, that’s exactly right. It’s like allergy, and it’s like autoimmune disorder. And I think many of us, particularly here on the West Coast, where we’ve, I think we’ve gotten a little more open and enlightened to the notion that you’re not just, you’re not… Forgive the phrasing, but it used to be said, “If you’re complaining, you’re whining about your aches and pains and joints and your stomach ache,” I think we understand now you’re not whining. |
| Matt Richtel: | That may well be a kind of chronic inflammation. Inflammation is a response of the immune system when there’s nothing to be attacked. And it, as our life goes on, our immune system can get more, caught out of balance, as I said. And so yes, it’s likened to that. |
| Matt Richtel: | I had the privilege to spend a lot of time with Anthony, Dr. Tony Fauci, who now is our national hero on this stuff. What an amazing guy. He really explained to me that there are no magic bullets to keeping the immune system balanced. |
| Matt Richtel: | But there are some really, there are three or four key habits, not magic bullets, but habits that you can do to keep your system in balance. And they are really, really helpful. |
| Matt Richtel: | So when I say no magic bullets, what I mean is, there’s a lot of marketing hype out there. “Boosts your immune system doing this,” which now you know you don’t want to do, or even, “balance your immune system.” Listen, don’t believe it, if someone says, “Wipe an avocado on your forehead,” and I’m a big guacamole guy. |
| Jeff Schechtman: | Right. |
| Matt Richtel: | You don’t need to paint your fingernails kale color. It’s not, this stuff doesn’t work. There are three or four things that work, and they’re all related, and they are keeping your stress low, keeping your sleep up, keeping a balanced diet, and getting some exercise. |
| Matt Richtel: | And I think it probably best helps to start with stress, because it, in many ways, is the most illustrative, and it is very scientifically based. So, I mean, it may be remarkable to some of you to hear the President and others get up and say, “Keep your stress low,” and think, “Come on, give me a break. That sounds like, what is this, the ’60s?” But it is not. It’s the ’20s again, and the science on stress is really deeply linked to the immune system. |
| Matt Richtel: | So, bottom line, is that, and then I’ll explain how this work, when your stress is high, it dampens your immune response. And the reason for this is, if you can picture yourself in primitive days being chased by a lion, that is, sets off what’s known as a fight or flight response. And going a little deeper, it’s what? It’s a series of hormones and neurochemicals, epinephrine and norepinephrine, that course through your body. They send your blood pressure up, they broaden your blood vessels, they heighten your focus. |
| Matt Richtel: | They’re really wonderful if you’re running from a lion, but they shift resources away from your immune system. They dampen your response to a virus. Now why would that be? Well, simply put, you have a finite amount of resources in your body, and if you’re trying to survive an acute problem, you don’t really need to worry about a head cold. |
| Matt Richtel: | If you’ve ever lost some sleep for a few nights, or been stressed during a finals exam, or at work and noticed that you got a cold sore, this is a prime example of how your immune system lets up a little bit, and a chronic virus like herpes, which is in a huge part of the population, begins to creep into your body. Here’s what to do. |
| Matt Richtel: | Right now, to the extent you can, focus on the present. You are at home and you are not sick. There ain’t no lion. How do you do that? Well, one thing is to not rely entirely on your intellect. When you rely on your intellect and say, “I shouldn’t worry, I shouldn’t worry, I shouldn’t worry,” you can oftentimes get spun up. Our family has begun beginning of the day, end of the day, two kids at home, my wife a doctor, dealing with this stuff herself, breathing with a guided meditation we found in an app. That’s one way to do it. |
| Matt Richtel: | Another way is to just sit quietly. Another way is to go for a walk. Exercise can keep your stress low, that adrenaline cycle low. You can go for a jog, go for a hike, play some tennis, I don’t know what it is. Get on the treadmill. Whatever you can do that keeps you away from other people and your exercise. |
| Jeff Schechtman: | One of the ironies of all of this, to your point, is that the fear of this right now, the reporting of it, the way everybody is taking all this information in, is really one of the biggest causes of stress. |
| Matt Richtel: | Yeah. I mean, there’s a big conversation we could have about media, and the pace of life, and I do think we are being asked, each of us individually, to begin to draw some lines. How much do I want to read? How much do I need to know? How much am I being caught up in a soap opera that doesn’t affect me? |
| Matt Richtel: | And you could have said this previously about politics. You could’ve said it about sports. You could have said it, go down the list. I think we are at a moment in time, when we need to take ownership of our own adrenaline cycles, our own calm, our own present moment. And there’s part of me that thinks, Jeff, without getting too existential, that like any addict, this society, this civilization, needs to hit rock bottom, until we decide that we are going to become less responsive to external stimulation. |
| Matt Richtel: | And that is in us, and this is a test right now. This is not a drill. Keep your stress low, take it on your own shoulders, in your own lungs, in your own heart. You have this power. I have spent many years, as a devotee of this science, and I can tell you, that person after person I’ve spoken with over the years, resists listening to their own muses, and get stuck listening to these external stimuli. This is a chance. |
| Jeff Schechtman: | Part of it also, and you have written so extensively about this, is the degree to which, in our modern age, technology mostly has created this kind of addiction to that dopamine hit, that then spills over into this kind of a situation. |
| Matt Richtel: | Yeah, I think this is, I think that is underneath some of this. It is very hard to tease out honest, quite honestly, the full of reality right now, because of the messages that are around us. But let’s, for a second, settle on some premises. |
| Matt Richtel: | Let’s settle on a premise that this virus is real, and that we entrust that the scientists and government around us are telling us that we can slow it down, to preserve our resources, to help people whose lungs are at the most risk. Let’s just settle on that premise, but once we settle on that, then can we divorce ourselves from the extra stimulation, the compulsive use of our devices? |
| Matt Richtel: | Can you set up some limits on your device? What if you stayed at home right now, and went back a little bit in time, read a book, talked to your spouse, went for a walk, lived with silence, learned that, perhaps, you can do without this device that so feeds your need for external stimulation. |
| Jeff Schechtman: | Somebody made the observation recently that with everybody locked up at home, one of two things were going to happen by the end of the year. Either the birth rate was going to go up, or the divorce rate would go up, or both. |
| Matt Richtel: | Well, that, I mean, that is, I’m laughing, because it’s such a wise observation. But let’s assume both for a minute. But honestly, I’ll be accused of cup half full here. I see this as a huge opportunity. I’ve written a piece for the Times that’s not out yet, but I think it’s an opportunity of a lifetime. |
| Matt Richtel: | And I think that opportunity is to live with some quiet, live with the person around us, not feed off the external stimulation. I mean, it’s, no one’s grading you right now. No one’s watching you right now. This is on you, to try to live with a little more silence. And here’s the bonus, Jeff. If you do, you might save your life. |
| Matt Richtel: | Because those tools that I’ve described will keep your immune system in balance. What if, for three months, you said, “I can live with a little less excitement, I can slow down in my life. This is a gift, not for society as a whole, but for me, should I choose to open it.” |
| Jeff Schechtman: | And really that’s beyond all the things we’ve been talking about. Kind of the overlay to all of this is that, where it takes us, when all of this is over? What does it look like the day after? How has the world changed? |
| Matt Richtel: | Yeah, it’s a great question, and as you ask it, what comes into my mind is, that we remain, struggling to look for meaning, and a lot of times these external forces gives us a momentary sense of meaning. I’ll be curious to see if this changes how much gratitude we feel, what we decide to respond to, whether things that used to upset us will be in a different perspective now, having felt something like this. |
| Matt Richtel: | But let me draw back, because we’ve gone very far afield. I think, for your own health and safety, and for that of your family, it’s just worth understanding that all of this links to the immune system. And in an acute sense, that is something you can balance by understanding the science around it. |
| Jeff Schechtman: | Matt Richtel, his book is An Elegant Defense: The Extraordinary New Science of the Immune System. Matt, it’s a pleasure to have you here on the
WhoWhatWhy podcast. Thank you so much for spending some time with us. |
| Matt Richtel: | Thank you very much, Jeff. |
| Jeff Schechtman: | Thank you. And thank you for listening and for joining us here on Radio WhoWhatWhy. I hope you join us next week for another Radio WhoWhatWhy podcast. I’m Jeff Schechtman. |
| Jeff Schechtman: | If you liked this podcast, please feel free to share and help others find it, by rating and reviewing it on iTunes. You can also support this podcast, and all the work we do, by going to whowhatwhy.org/donate. |
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