I had an appointment with a substitute doctor this week. Attesting to his renown, his office walls were crowded with yearly awards demonstrating his leadership in his field.
He is a hematologist/oncologist. I was there to receive one of the twice-yearly injections I receive for osteoporosis. The same medication is given in greater strength and frequency to cancer patients to prevent bone fractures.
As he leaned forward to give me the injection, his mask was comfortably positioned beneath his nose.
I was distressed by his apparent carelessness: the man deals with cancer patients all day long, for goodness sake.
I was also amused, as it reminded me of a cartoon I’d seen, which I hope does not offend. I think it makes an important point in a memorable way.
Two roughly drawn panels—black outline, white interior. Inside the left panel is a sketch of a man with a long thin face and long thin nose. His mask is comfortably positioned beneath his nose. The legend reads: “Wearing your mask like this…”
The right panel features a full-length sketch of the same man. That legend reads: “…is like wearing your underwear like this.”
But this was serious business, so I asked the doctor about his mask.
“I had COVID in March,” he told me. “I lost weight and slept a lot, and on the 14th day, I got up and could have run a marathon.”
He added that his wife, daughters, and one daughter’s boyfriend had also had mild cases and fully recovered. “And,” he said with certainty, “I’ll never get it again.”
I questioned him about the antibodies, which my reading had suggested was far from a settled matter. In fact, there are more than 100 vaccines in the works that are based on antibodies. But some people who recover never have antibodies, and others have them only briefly.
“It’s not the antibodies,” he responded. “It’s the T cells. They carry memory of the virus and prevent it from reinfecting.”
He said he was so sure he’s safe that he often greets his elderly neighbor with a hug, unworried that he might infect her.
Huh! Or more specifically, Huh?
I had heard the T-cell theory, so I did a little research. In fact, there’s some exciting emerging research based on T cells and the coronavirus. Little had been known til recently about the role of the T cells in SARS-CoV-2, the virus that causes COVID-19.
For much of the following, I’m relying on Derek Lowe, who writes about drug discovery and pharma for In the Pipeline, an “editorially independent blog from the publishers of Science Translational Medicine.”
In May, Lowe wrote:
“One of the big (and so far unanswered) questions about the coronavirus epidemic is what kind of immunity people have after becoming infected. This is important for the idea of ‘re-infection’ (is it even possible?) and of course for vaccine development.”
I’ll spare you Lowe’s careful explanation of the various and complex aspects of our immune systems; if you’re interested, you can read it via the above link.
Instead, we’ll focus on two primary types of T cells. One is CD8+ T cells (among other names), which kill the virus-infected cells “before they can break open and spread more viral particles,” writes Lowe.
“And then there’s another crowd, the CD4+ T cells, also known as T-helper cells and by other names…The helper T cells have a list of immune functions as long as your leg, interacting with many other cell types.”
Those immune functions include spurring the CD8+ cells and “activating B cells to start producing specific antibodies,” among other tasks.
Lowe describes what I think of as the “Goldilocks response” to COVID-19:
“What you want: a robust response that clears the virus, remembers what happened for later, and doesn’t go on to attack the body’s own tissues in the process.”
This was what a team from La Jolla Institute for Immunology in California and Mt. Sinai in New York was studying. Comparing infected patients who’d recovered with those who hadn’t been exposed to the virus, they found all the exposed patients had CD4+ cells that responded to three specific proteins: Spike, M, and N.
Lowe suggested that this discovery made the prospect of a vaccine more likely, and that though most efforts have been focused on Spike, adding the other proteins to the mix might further strengthen a vaccine’s efficacy.
Another study suggested that the memory T cells may protect some people with COVID-19 because they “remember” previous encounters with other human coronaviruses.
Of the large family of coronaviruses, six of them have been found in humans. Four are responsible for the common cold. The other two are more dangerous; they caused SARS (SARS-CoV-1) and MERS (MERS-CoV). ( I assume that means SARS-CoV-2 is number seven.)
Here’s the cool part: in that second study, reported in Nature, Antonio Bertoletti of the Duke NUS Medical School in Singapore and his team looked at blood samples from people who’d recently recovered from mild to severe COVID-19. They all produced T cells that recognized many parts of the SARS-CoV-2 virus.
Then they looked at blood samples from people who’d also survived SARS 17 years ago—and their memory T cells from that illness also recognized parts of SARS-CoV-1.
Apparently, their immune systems were still attuned to protecting against the disease 17 years later.
After that, they checked for these T cells in blood samples from healthy people who’d had neither SARS nor COVID-19—and more than half had T cells that recognize one or more of the proteins under study.
So it’s possible that there are people who have some immunity to COVID-19 based on their previous bouts with the common cold.
“This makes one think, as many have been wondering, that T-cell driven immunity is perhaps the way to reconcile the apparent paradox between (1) antibody responses that seem to be dropping week by week in convalescent patients but (2) few (if any) reliable reports of actual re-infection. That would be good news indeed.”
Francis Collins, MD, who heads the National Institutes of Health, writes cautiously in the NIH Director’s Blog:
“It’s still not clear if this acquired immunity stems from previous infection with coronaviruses that cause the common cold or perhaps from exposure to other as-yet unknown coronaviruses.
“What’s clear from this study is our past experiences with coronavirus infections may have something important to tell us about COVID-19. Bertoletti’s team and others are pursuing this intriguing lead to see where it will lead—not only in explaining our varied responses to the virus, but also in designing new treatments and optimized vaccines.”
These studies may have huge implications in helping us combat COVID-19.
Bottom line for me: When I see that doctor again for my injection in 6 months, though I hope he’s wearing his mask properly, I won’t be quite as worried as I was this time. The degree of his certitude may not yet be warranted, but at least his decision is based on some solid emerging research.
Annie
annieasksyou... 
super interesting!
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Thank you, Matt! Much appreciated!
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Another amazing display of brilliance
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Aw, dear friend. I didn’t dare wade too far into the immune system bc I would have tripped up on the T cells and have been no “helper” at all. XO
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Interesting. When I recently went to the doctor for my shoulder pain I was also keenly aware that he was wearing his face mask below his nose. It made me feel uncomfortable and I think he noticed my discomfort because he made sure to tell me that he has already had the virus and tested positive for antibodies. He didn’t mention T Cells though.
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It is interesting. I sure hope they’re right. Lowe did say that there’s very little evidence of actual reinfection. If that’s the case, and so many people recover and don’t have antibodies, that seems to support the T-cell research—unless there’s some other factor not yet identified. Thanks for adding your recent experience.
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Fascinating research, Anne. Have been reading your brilliant blogs all along. Really appreciate your astute comments and facts.
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Thanks so much, Dr Sally. I’m so pleased to know you’ve been following my blog—and especially grateful for this comment in view of your scientific pedigree.
Stay safe.
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Good research and educational. But for me, I tend to wait until all the evidence is in. I think the doctor was wrong to put you at risk for 2 reasons. First, the research is not complete. Second. Even if HE can’t suffer the effects of the virus, does that mean that he can’t be a carrier and infect others? Is it possible that he can be infected by the virus, and while his own T cells are fighting it off, he could still infect others?
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You always raise good questions, Joseph. Obviously, there are still so many unknowns with this disease. But since he has a very busy practice and has been back to work since April —if not earlier—and he’s working daily with immunocompromised patients, I think if he were infecting anyone, it would already have been evident.
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Until we all know for sure, tell that Dr. to wear his f…king mask properly .
Sent from my iPhone
>
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Do I tell him before or after he stabs me with the needle he’s armed with?😉
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Here’s hoping that an effective vaccine is available by the time of your next appointment with this (actually, with any) doctor.
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Thanks, Gail.
Though I am the antithesis of an anti-vaxxer, I am deeply mistrustful of this administration’s efforts to rush a vaccine to market. They are pouring money into companies that have never made a vaccine before. Moderna, whose product is garnering a lot of excitement, has never successfully brought a single drug to market.
So I asked my endocrinologist. Though this isn’t her field, she has been the principal investigator on many worldwide clinical trials for osteoporosis meds, and I have confidence in her careful judgment.
Her response:”Listen to Dr Fauci. If he says it’s safe, it’s safe.”
On a separate issue, I’m having WordPress problems. One is with the “like” function. I don’t mean to put you on the spot, but did you click on it for this post? Would be helpful for me to know. Many thanks, and take care.
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Thanks very much, Gail.
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I’ve been having problems with the “like” function for a while, so I gave up trying. This time, however, it worked! Be aware that I like all of your posts, even if my official “ like” isn’t recorded.
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Thank you so much; that’s great to hear. But I wish WordPress wouldn’t make things so hard!
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Annie,
Would it have killed your doc to wear the mask if for no other reasons than to set a good example and that his clients are uncomfortable with his 1/2 masked face? His attempt at bravado would have sent me looking for a new doc.
Interesting post and maybe the science is going to lead to promising results.
DtD
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Actually, he said he lowers it occasionally because it fogs his glasses.
I think it was less bravado than it was his absolute certainty. And since my choices are that I see him—or one of his colleagues— in six months, or sit in a crowded room at the hospital where my drs’ asst told me people weren’t wearing masks and were walking around talking on their cell phones— or get a prescription from my dr to self-inject—to the tune of $800 bc that’s my copay when no health professional is involved, I plan to stay with the guy with certitude. Thanks, though.
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Fascinating post and thank you for sharing
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Thanks so much for breaking through my WP travails, Sheree. Much appreciated. My “Mid-Pandemic, Anti-Panic, Slightly Manic Flight of…Oh, I Dunno” also didn’t make it to you, I believe. That’s short and light, if you’re interested. By the way, the “like” feature isn’t working either.
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It sounds to me like your doctor and the research you have reviewed is another way of saying that the idea of herd immunity has some legs after all. Mankind has been assaulted by communicable diseases for who knows how many millennia and we’re still here even without modern medicine for all but the last, what, 80 years? If the science doesn’t replicate or explain reality, there’s something wrong with the science.
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Herd mentality sure didn’t turn out well for the U.K. or Sweden. And if you assume that was the thinking of the governors in Florida and Texas and elsewhere, it sure hasn’t turned out well there either.
Maybe it works in Malthusian terms, but anyone who cares about the massive death and suffering worldwide can’t possibly be satisfied with the implications of following herd mentality as an approach to this dreadful disease.
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Fascinating. On a side note, I’ll be really interested to see how the politics around distribution of any vaccine develop.
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That’s another huge issue, Matthew. One day after I expressed my concerns about our government’s pouring money into companies with no experience successfully bringing vaccines to market (see response to Gail above), The NY Times headlines :”Scientists Fret as White House Rushes Vaccine.”
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Interesting and well researched, as always, Annie.
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Thanks, Len. Much appreciated.
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I’m wearing a mask and a shield
To protect all nearby as I wield
My scissors about
With questions and doubt
For those in the medical field!
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That is just the best, my friend!
Love it!
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💛🙏🏻🧡
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Ditto. We’ll talk scissors soon!
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I’m with the “wear your mask properly, Doc!” sentiment. Meanwhile, fascinating research here. Gives me hope. Agree with one of your readers here who calls your work “brilliant” — so thank you! I know these posts are work and presuming to speak for a bunch of us, we, your faithful, appreciate it!
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That is just the loveliest sentiment for me to read as I start my day.
Though I don’t think I warrant that accolade, I’m the one who’s lucky to have such consistent and thoughtful readers as you, Denise—you who became a leading musician without learning to read music. Now that’s brilliance!
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Inspiring 👍
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I’m glad you think so.,Welcome to annieasksyou, and thank you for liking several of my recent posts.
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That’s interesting and potentially give hope for a way to finally lick this virus. But until more is known about its efficacy, I’ll continue to social distance and wear a mask and keep away from those who refuse to do so!
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Understood!
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Annie,
That is potentially great news if it bears out to be true for one and all. I’m glad you asked the right questions and that led you to continue researching the subject. There are so many unknowns and from the mainstream news, I haven’t heard anything about T-Cells. Even so, it would seem that unless your doctor is someone who doesn’t think wearing masks is important, he’d do so just to make his clients feel more comfortable as well as being a good role model. I hope he is right in all that he said! As always, informative and great story! Mona
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Thanks, Mona! I think I noted to another commenter that he said the masks fog his glasses, so he was essentially “getting some air.” I think he wears one most of the time but feels very confident—possibly overconfident—that he can’t infect anyone else. Since late March or early April, he’s gotten away with it. And as I saw him more than three weeks ago, I’m quite sure he didn’t infect me. (I’m making that little clucking noise to myself that my mother used to make to ward off the evil spirits—just in case!)
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