By Paul Ehrlich, MD
The title above is from an excellent article in The Atlantic by science writer Ed Yong entitled “Immunology Is Where Intuition Goes to Die”
which analyzes brilliantly the nature of the immune system and its paradoxes, which have been exposed day by day in the news. The article explicates the different stages of immunity, from innate through acquired, with the familiar cast of cytokines, chemokines, interferons and so forth, which are our friends until they are not.
There’s no bigger paradox to me than the fact that I am still alive while my friend and colleague Larry Chiaramonte is not. As we told you a couple of months ago, Larry passed away in an assisted living facility. I live in an apartment. He was older than I am by about eight or nine years. He was widowed. I am not. These are just a few items that might have relevance to a study of risk. I believe I also had Covid-19. For six weeks I had symptoms. Fatigue. Runny nose. Congestion.
I might very easily have been exposed on my commute by subway, or in my office, which was open every day right up until everything shut down. Most of my patients are children who are less vulnerable to the virus, although as we now know they are not invulnerable, and they can also be asymptomatic spreaders. As Mr. Yong puts it, children have “trigger happy immune systems.” When it comes to fighting off viruses, this is a good thing. When it comes to allergies, not so much, although it has been suggested that allergies and asthma may help resist SARS-CoV-2—another paradox. We don’t know. Weirder and weirder.
When I was feeling miserable this spring, I did a mental inventory of my own immune system. I’m 75. When I was a toddler, my father, a pediatrician, practiced in our house. His waiting room was our living room where I played while the patients came and went. His examining room was my bedroom at night. Dr. Lennie, as he was known to generations of Long Island children, decided to inoculate me to the full menu of childhood diseases by exposing me to his patients. There were no vaccines. I got them all, thankfully mild cases. He practiced until the 1990’s by which time he gave the shots instead. The only exceptions were polio cases. He would arrange for me to be away when he knew one would be coming in. Eventually, his old medical school friend Jonas Salk came up with a polio vaccine.
After I recovered from my illness this spring, I went for blood work. In addition to looking for Covid-19 antibodies, I asked the phlebotomist to test for measles, mumps, rubella, and chickenpox. To my not quite surprise, I still had powerful titers to those diseases. To my greater surprise, I had no Covid-19 antibodies. Had I had the disease? I suspect that my early exposure to a full roster of viruses all those years ago had something to do with it, a kind of suburban version of the “barnyard effect.” Maybe it’s because I have been listening to children’s hearts all these years, looking in their noses and ears. Their colds are coronaviruses, too. Maybe this gave me an advantage in confronting a novel virus. Lots of my contemporaries live the hygiene hypothesis life. Their immunity isn’t challenged day by day to renew itself. One more idea to throw into the hopper.
How then to explain what happened to Larry? He practiced in the South Bronx for many years where he confronted if anything more pathology than I did. But then he retired and he ended up living comfortably in the kind of facility that we now know to be a hotspot. He was a great doctor and a visionary immunologist. I would love to talk to him about this now. And Dr. Lennie. Both of them would have been fascinated.
Anyway, read Yong’s article. It is the clearest and liveliest exposition of the mysteries of immunology I have ever read.