Hello, this is Dr. Russell Kohl, chief medical officer at TMF Health Quality Institute, with another installation of our Medical Minute. I’m joined today by Dr. Clifford Moy, TMF’s behavioral health medical director. In today’s episode, we’re going to give an introduction and a very high level overview about the topic of vaccines and immunity. This is a very important topics in the evolving COVID-19 pandemic. We hope the information in this and other podcasts we produce will help you to understand and explain the situation more fully to your staff and to the residents of your facilities. Our objective today is simply, how does the body defend against infections? How can vaccines improve immunity? I’m going to now turn the microphone over to my colleague, Dr. Moy. DR. MOY: Thank you, Dr. Kohl. This is Dr. Moy, and I'm going to talk a little bit about what happens in a viral infection. Viruses aren't able to live on their own, so they do need to take over or infect a host cell to be able to do what they are designed to do, which is to reproduce. The virus will enter the host or invade the host cell, use all of its cellular mechanisms and its energy to make more copies of itself, of the virus. The cells are injured. They get weak, and eventually, they'll be destroyed because the virus reproduction just kills the cell. We know that different viruses affect different organs or tissues. We may have some viruses like influenza or the virus that causes COVID-19 that predominantly affect the respiratory system and then we have all sorts of gastrointestinal viruses like the Norovirus. We've seen that on cruise ships causing nausea, vomiting, and diarrhea. I think Dr. Kohl is going to take this next section.
DR. KOHL: Great. Certainly. I can jump right in here. We understand that viruses exist in the world, and that they're attempting to get into our bodies. So how is it that we fight them off? The first is, if it can't actually get into the body at all, then it can't get into your cells in order to create disease. So that's the use of physical barriers. Simply the skin, think about the PPE, masks, gloves. Those are physical barriers that keep the virus from getting into your body. Once they get past that outside physical barrier, there are inside defenses. So think about stomach acid as an example. You may eat a food that is no longer good. It doesn't always result in food poisoning because there are many different bacteria that the acid in your stomach will use to break down that particular bacteria. Think about snot. You know, the fact that the virus made it to your nose doesn't really matter if it has been moved out of your nose by a large flowing amount of snot in a runny nose. Those are nonspecific defenses that your body has. Now, once the virus does make it inside your body and past those internal defenses, your body actually has two separate systems that it uses to then attack and get rid of the viruses or bacteria. One of those is very nonspecific. It is essentially cells that wander around your body looking for anything that doesn't look like it should be here and attacking it. The other type, which you've heard a lot more about is your targeted immune system. That's the creation of antibodies. So when your body sees something that isn't supposed to be here, it breaks it down, looks for specific parts to it, and then will create things called antibodies, which will react to those specific parts. Those antibodies sometimes have cross reactivity. So think about, as you've heard of all the different mutations and those things of COVID-19, some of the antibodies can hit three or four different mutant species. The trick is, is it an antibody to a part of the virus that hasn't changed? If that part hasn't changed, then the antibody will continue to work. If that part does change, then the antibody will not be as effective at recognizing it. With that, we can go ahead and move on to the next topic. I think Dr. Moy is going to lead this discussion.
DR. MOY: As Dr. Kohl mentioned, our first line of defense is always the exterior defense, the outside defense. That's why we've emphasized the use of personal protective equipment, or PPE, during this pandemic, having masks, wearing gloves, even having face shields at times when we were learning about the virus. We know that hand washing is an incredibly important component to all infection control and to this particular virus. In lieu of hand washing, sometimes we use hand sanitizer, which is a reasonably good alternative, but I'll tell you nothing beats washing your hands. So we want to continue emphasizing hand washing and PPE in facilities, even if you're vaccinated. Think back several years when we were in the midst of the HIV epidemic, and we developed a concept of universal precautions. We probably need to go back to thinking about universal precautions especially inside health care facilities so that we can maintain a consistency, a regularity of doing all the things we need to do to be safe from using masks and gloves, hand washing, needle safety, body and fluid protection. Those are all things that we need to just get ingrained in our daily habits of work. There are other methods to prevent viral infections, chemical things, but really, we just need to think about using these basic infection control techniques. During a recent webinar TMF hosted, we learned that some nursing home facilities have started having staff validate one another to ensure they are donning and doffing PPE correctly. This strategy gives the nursing home staff a chance to use a checklist to make sure they are following the steps correctly. It gives the staff the opportunity to learn from each other and teach each other, so it isn’t just one person monitoring, but everybody monitoring and helping to ensure the safety of staff and residents.
DR. KOHL: I agree, I like to think about the Swiss cheese concept of protection as well. Each layer or protection is a piece of Swiss cheese with the holes in it. Your PPE, your skin, then your body's innate defenses. Then your antibodies. Another piece of cheese you can put on there to block the holes is cutting down just the number of viruses in the ambient environment. Those UV sterilizers that are able to actually break down the virus in the air are a great tool and are something that you're seeing more and more of, more in hospitals, but certainly I know some of the nursing homes I've worked with have installed those in common areas to be able to just reduce the number of viruses that are in the air. Dr. Moy, I also had one facility which uses PPE and hand washing songs. They do this during their stand up meetings. They have a song, like a rhyme with the proper sequence of hand washing. They do it two minutes before the stand ups. That's how they are maintaining hygiene. Well, we hope you found this introduction to immunity and ways to beef up your immunity helpful. Please listen to our two other podcasts that give more information about why we vaccinate and an explanation of herd immunity. With that, once again I’m Russell Kohl, chief medical officer and family physician at TMF Health Quality Institute. Keep up the good work, and don’t forget to keep making the world a better place. – END –