Patient questions On Covid-19
I’m going to take this opportunity to answer a few of the many questions I am receiving by email text and phone calls as best I can given the current knowledge about COVID-19 (4-4-20).
I have chronic fatigue syndrome does that make me more likely to catch COVID-19?
No. I’m pretty confident about this, mainly because most of my chronic fatigue syndrome patients live a life that is more congruent with self isolation and self quarantine than the normal person. At their sickest, they are unlikely to be out and about meeting other people, so the opportunities for contagion a very low. This does not mean that you can ignore the advice about avoiding the Coronavirus (which I have dealt with in my previous blog). Everybody should be doing that right at the moment.
You should be focusing on the things you can do to improve your health and reduce the risk of infection in the first place, and this is dealt with here.
If I catch COVID-19, does having CFS put me at risk of severe complications, or even possibly dying?
To the best of my knowledge, you are not at all at increased risk of complications or dying. If you suffer from heart disease, hypertension, diabetes, long disease and possibly kidney disease, you may be at higher risk of complications, but this is one of the big unanswered questions. Some anecdotal evidence suggests that the gastrointestinal tract may be an entry point for some who go on to develop severe disease, and it is worthwhile maintaining good gut health throughout this period of potential viral exposure.
I suffer from chronic and repeated Epstein-Barr virus infection. Doesn’t that make my immune system fight harder and wouldn’t that make the risks of inflammation greater?
In theory, that is possible. The problem is that no one has yet certain about what type of immune response (too vigourous, normal or too slack) is best for avoiding the complications of the coronavirus. It looks like having a vigourous response early in the illness may prevent it progressing and prevent complications, but that later on, in the second week usually, an uncontrolled “cytokine storm“ may lead on to complications. This happens mainly in the older population, and the older you are the more likely this is to happen.
Epstein-Barr virus does invade what we call naive B lymphocytes. These are the antibody-producing lymphocytes of the body, and “naive” means they do not yet have a job to do and haven’t seen the virus before. They are ready to go into battle when something new like this coronavirus comes along, and they can provoke a fairly vigourous clonal expansion of those B lymphocytes, making you feel sick much of the time. This is not, however, a “cytokine storm”.
As well, current evidence is that complications arise when the T-lymphocytes drop away markedly and the innate immune response (neutrophils) escalates sharply. This is called a rising NLR, or“neutrophil – lymphocyte ratio“, and the typical ratios in my chronic fatigue syndrome patients are between 1:1 and 2:1. Complications seem to arise as this exceeds 10:1, with reports of worst complications are between 30:1 and 50:1.
In other words, I think there is plenty of “headroom” in patients suffering chronic fatigue syndrome for them to respond appropriately to the coronavirus if they are infected. As well, my own patients are adapted to maintaining an immune balance that does not get out of control, but grumbles away below the surface.
I am not going to be definite on this until we have some further evidence, My honest feeling is that the Epstein-Barr virus often provides a kind of immune system exercise and challenge and that maybe sufferers are more capable of managing a novel virus such as the coronavirus without catastrophe than others with chronic medical conditions such as hypertension, heart disease, diabetes, and respiratory disease..
More to follow
