COVID-19, Air Travel, and Australian Open

COVID-19, Air Travel, and Australian Open

What is the fair proof of immunity against COVID virus for air travelers?

How should we accommodate the needs of anti-vaxxers in our world?

COVID-related immunological concepts made easy for everyone!

Mini Review of Diagnostic and Serological COVID Tests

Covid Vaccination Document, Australian Open, and Novak Djokovic Controversy

Novak Djokovic, the Serbian tennis player, was unknown to me until the COVID-19 controversy made him a shooting star who landed in Australia! The widespread media coverage of his story reignited my staunch conviction that the best of all immune defenses against COVID is confronting this rascal, head-to-head through close encounters, and to knock it down with our immune system.

These days, the irrational political animosity of vaxxers and anti-vaxxers has become so divisive across the globe that we fail to even appreciate the self-evident and remarkable qualities that proponents of each can offer to humanity! I tend to believe that all people by nature consider traits such as justice, fairness, kindness, truthfulness, sincerity, courage, temperance, patience, good health, and the like as virtuous qualities. I believe that these are qualities that most, if not all, people tend to agree that are inherently good to possess. Before I go any further, let me ask you this: do you agree with me on what I just said? I just hope that you wouldn’t want to tell me that I’m dead wrong on this! If you do…it will shatter my entire worldly moral outlook! It has been my observation that in recent years, we have progressively become so politically obsessed with smashing our opponents, that we tend to deny them even health-related virtues or positive attributes that we always used to adore. It appears to me that whatever we used to consider to be inherently virtuous, if it is mentioned by our political adversaries, we turn it into a vice, and in retaliation, whatever we used to consider a vice, they turn into a virtue for us! Had we always been this way? Or is it the morbid COVID that has turned our covert subliminal beliefs into overt intolerant behaviors? For now, all that I wish for is that we do not spoil the matters relating to our health and wellbeing with our feisty politics! I think it is only fair if I say this: whatever your political views are, “good for you”, and I full-heartedly welcome you to do the same for me! Would it be possible for us to make health and well-being related matters apolitical? I understand that this is extremely hard to do…at least, for so many people across the globe. But in the country of the free, this shouldn’t be very difficult to do! Wouldn’t it be nice if instead of imposing one universal rule over everyone, we use one fair rule for the vaxxers and another for the antivaxxers?  What if we agree on something like this: I give up one of my preferred social choices that I’ve always kept close to my heart, and you give up one of yours in return…don’t you agree that this will make our political games much fairer for everyone? 

Domination of the World by Political Divide of Vaxxers and Antivaxxers!

Having said all this, let us see how we can relate them to the Novak’s case! In my opinion, the use of vaccination status as the only valid document for air-travel or admittance into any country is extremely unfair to diehard anti-vaxxers! No matter how I look at it, it infringes on their rights, particularly in the country of the free! In my opinion the best of all rules is to use two reasonable medical science supported rules, one for those who believe in vaxxing and one for those who’re adamantly against it!  How can we do this? Here’s what I think we should do: we should use the evidence of past vaccination(s) and/or COVID antibody serology for this purpose, and either of these two should suffice as a gold standard for admittance onto the planes or into other countries! The first one is for those who believe in vaccination, and the other, for those who are anti-vaxxers and would rather confront the COVID head-to-head! I must add that evidence of truly positive COVID infection within a reasonable past period should also suffice as a good measure of immunity against the virus. For those who are familiar with the basics of immunology, my latter remark essentially means “evidence of positive COVID serology“! You may like to ask me “what should we do for the ones who prefer neither of the two”? My answer is obvious…they should isolate themselves at their homes, and if they are lucky enough to live in a non-congested rural area, to avoid unnecessary socializations and intermingling with other people!

As I was writing the latter remarks it occurred to me that some of my readers may have no clue about COVID serology! So, I thought it may not be a bad idea if I provide a simplified overview of immunological concepts as they relate to current controversies surrounding the COVID-19 virus. For my medical students and those who are genuinely interested in the knowledge of immunology, I suggest that they should download the entire 2020 edition of my medical immunology by clicking on this link: https://nmrtestbuster.com/download/bare-minimum-immunology-online/. For those of you who’re interested to freely access videos that accompany my book, all you need to do is to send an email to contact@ConquestofLongevity.com or Contactus@NorthwesternMedicalReview.com.

COVID-19: A Simplified Mini-Review of Relevant Hardcore Medical Science Stuffs…

How do we know that a person has already been exposed to certain pathogens…whether a bacterium or a virus such as the coronavirus? The serum analysis of those who have recovered from infections with any pathogen show a reasonable titer of certain antibodies…the so-called IgG antibodies (immunoglobulin G) against that pathogen. IgG’s are one of the five subtypes of antibodies that our bodies make, and their presence confirm past exposure(s) to specific pathogens. Of course, as you can guess our bodies can make a countless number of IgG antibodies against almost any pathogen that we may encounter throughout our lives. Our immune systems can make at least one antibody and often so many of them against any parts of the pathogens that have already breached our bodies. If you don’t know what an antibody is; it is a molecule made by our immune system, and it neutralizes or counteracts the destructive effects of pathogens! The antibodies often appear about 7 to 14 days after our exposures to most pathogens, including COVID viruses. How do we identify them in our blood? They are commonly detected by a laboratory technique known as Enzyme-Linked Immunosorbent Assay (ELISA). For now, just imagine that a lovely hardworking lab technician, named Lisa, is the one who identifies them for us! Currently, it is believed that the anti-COVID IgG’s last up to about one year in properly vaccinated individuals or those who’ve recovered from COVID-19 infection! What happens to the antibodies over time? As you can guess they will gradually taper off in our blood! They are tapered off almost in the same manner that we forget our memories of the past…that is, in a gradual manner! What does the presence of these antibodies in our blood do for us? They will help us to defend ourselves against later COVID encounters by reducing the intensity or severity of our future COVID acquisitions! What do the booster COVID shots do for us? They act as a boot camp training for our immune systems, and they keep our defensive skills sharpened! What is by far the most sensitive test to verify that our body has already confronted the COVID virus once or more than once in the past? This is verified by the presence of the IgG antibodies against the COVID virus! This is by far the most accurate evidence of the past exposures to- and presence of some levels of immunity against future COVID infections. Is the IgG the only type of antibody that our immune system produces against the pathogens? The answer is “no”, as our immune system can make several other isotypes or forms of antibodies against pathogens in general, and against the COVID virus in particular!

Types of Immunoglobulins and Their Structures

Each of the antibody forms serve a unique defensive purpose against the very same pathogen. To use an analogy, if as a country we’re at war against an enemy, our Air Force confronts our enemy on the skies, our Navy on the seas, and our Army infantries on the lands! Likewise, our immune system makes five antibody types against every pathogenic foe. Some of these appear early and some later during our confrontations. What are the top two noteworthy antibodies that often appear within the first few weeks of encounter with any pathogen, including the COVID virus? The two noteworthy ones are the IgM and IgA antibodies! For the sake of simplicity, let’s call these two the first antibody responders! IgA is the one that is specialized in encountering the COVID virus on the surfaces of our bodily mucosa; that is, where our inner body surfaces, such as mouth, nostrils, digestive system, and lungs encounter the pathogens! Imagine that this immunoglobulin is a soldier who must get out of our bodily castle to defend us on the outside walls of our castle! What do the IgM antibodies do? They confront the bugs when they enter into our bloodstream!  Do our bodies show any traces of these two antibodies upon our subsequent encounters with the COVID virus? You bet they do! The IgA and IgM are our first immunologic responders that confront our foes! If serology of a patient shows high titers of these two antibodies, they are indicative of a new encounter with any specific foe such as the COVID virus. Let’s call this a new infection! So, what does identify a new infection in a patient who has confronted it for the first time or after a repeat encounter? Presence of IgM (and IgA) that are specific to that pathogen!  From what I just mentioned you can gather that our immunologists have  already learned how to figure out if our bodies are recently breached by a new or old foe! This is the foundation of serological testing for identifying recent exposures to any pathogen! Again, what serological markers tell us about this? The rising titers of IgM and IgA antibodies! If IgM and IgA are like our first responders, what functions do the IgG’s perform? They are the antibody isotopes (forms) who treat us and make the infections go away! Analogically they act like the nurses and doctors in the emergency departments of our hospitals! They are the ones who remember the memories of our past encounters with the COVID virus! They are the ones who will bust off our infections!

Mothers and Their Babies! Oops…. I just remembered that I’ve left out something very important  that all expectant mothers or parents of newly born babies love to know! Don’t you all love to know why normal neonates  of the vaccinated moms or those moms who have already contracted the COVID, are often immune to the COVID for the first few months of their lives? Here’s how: the IgG antibodies  that the moms make against the COVID pass through the navel string or the umbilical cord to the fetus!

Analogically IgGs act like the nurses and doctors in the emergency departments of our hospitals!

I’m so sorry for throwing so much medical jargon at you, but for the sake of completeness I should add this final note: for some viral diseases such as acute hepatitis B, measles, rubella, dengue, and polio, a onetime recovery from the disease translates to lifelong immunization against them.  What does this mean? It means that our immune systems can produce IgG’s against them forever! It means that our immune system never forgets the memory of its first encounter with them! Is there anything that you never forget in your life? The street number of your childhood home! The lip kiss of your first love! The smell of your first pastry! Please don’t ask me…why you remember them all? Because I just don’t know why, and whatever I tell you is purely speculative…at least…for now! Oh, my goodness… did you notice what I just did? I tried to hide my ignorance by attacking you and saying, “why do you ask so many questions!”, “are you now happy that I almost forgot what I wanted to tell you in the first place”! Well, don’t worry I will tell you what I had in mind…here it is: for some viruses such the Beta- COVID, Delta- COVID and Omicron, the common belief, that is yet evolving, is that we get up to about one year of immunological memory! Interestingly, our immunologic memories of other major causes of  common cold such as rhinovirus or influenza also last about up to one year!  

About Asymptomatic Infected Patients: I almost forgot another important concept that I wanted to share with you! I’m glad that I remembered it! Let’s go through it! The serological studies that I described above take some time to complete! Individuals who are positive for them, either are already symptomatic, such individuals who show a rising titer of IgM against COVID, or they are partially immune, because they have a high titer of the IgG against COVID! What about those people who have recently contracted COVID and can spread it to everyone in their close proximities, but have not yet presented with symptoms of it such as fever, cough, or muscle pain? I’ll tell you… these are the people that you must be worried about! Why? Because you always get it when and where you don’t expect it! Where is by far the most dreaded place to mingle with the latter people? In the airplanes! Well, this is what I am about to explain for you now!

Watch for COVID Dissemination Here!

Let me start by this: if you plan to travel back to the US, or if you’re an international traveler who plans to come to the US, you are required to get a COVID-19 viral test no more than 24 hours before you travel by air into the United States. You must show your negative result to the airline before you board your flight. You may find more information regarding your travel to the US by visiting the US Center for Disease Control at this link:  https://www.cdc.gov/coronavirus/2019-ncov/travelers/testing-international-air-travelers.html. Well, I guess, now, your most pressing question for me must be about the diagnostic tests for COVID! Did I read your mind correctly?

COVID-19 Diagnostic Tests: Well, the COVID-19 test that you have to take within a day before your travel is the so-called “rapid test”. This test that is performed by nasal swabs, is also known as the antigen test. What does it do? It identifies specific proteins on the surface of COVID-19. The mechanism of this test includes use of antibodies that interact with the proteins on the surface of the COVID virus, and then become highlighted or detected by assuming bright colors that are detectible by the naked eye. The most important value of this test is that it takes anytime from a few minutes for home tests, and up to one day for certain labs to provide the results. The most commonly neglected problem associated with this test is that it labels people as not having COVID despite having it! This is what the docs call “false negatives”. The false-negative travelers are by far the most common source of COVID dissemination on airplanes!

Another test that is relatively rapid is the PCR COVID-19 test, that is also known as the molecular test, and polymerase chain reaction test. What does this test identify? It identifies the genetic materials that are specific to COVID-19! More specifically it identifies ribonucleic acid (RNA) that is specific to COVID-19. In contrast to the rapid antigen test, the PCR test has far fewer false-negatives (i.e. those who look fine but are positive for the Covid). In other words, it can more readily identify asymptomatic COVID patients! The most important drawback of this test is that it must be done in the labs, and takes 1-3 days to yield the results. These delays often lead to spread of the virus to other people while asymptomatic true-positive patients are awaiting to receive their results. If you’re interested to know more about the available tests for the COVID, and in particular if you don’t mind scientific jargon, this is the link that I highly suggest to you: https://en.wikipedia.org/wiki/COVID-19_testing

Epilogue: Air Travel in Post-COVID Era

Air travel and Immunity Passport

To wrap up my thoughts for today, I’m again obliged to reiterate that it is fair and scientifically sound if we employ a compromised rule for travelers: the vaxx document for the vaxxers, and evidence of positive IgG serology for the anti-vaxxers. Again, had it not been for the heated controversy surrounding the case of Mr. Novak Djokovic, it wouldn’t have even occurred to me to write this blog. What his case did for me was to reignite my predictions for post-COVID era air travelers. If interested, you may learn more about my trains of thoughts by browsing through the following few lines.

On July 3 of 2020, I felt the need of posting a Facebook note about the post-COVID air travelers and share my predictions about it. If you like to feel what I felt at that time, you may click on this link:

https://northwesternmedicalreview.com/index.php/covid-19-air-travel-and-adjusting-to-our-changing-world/

On August 24, 2021, after I learned that several of my medical students have contracted COVID-19, I felt the urge to post what you will see by clicking on the following link. Guess what? If you click on this link, you will know why I am so envious about all those who have contracted and recovered from COVID with or without having COVID vaccinations!

https://www.facebook.com/NorthwesternMedicalReview/posts/4249244795113256

Hope to catch you all healthily down the road!

Dr. E

By

Also known as "Dr. Testbuster", Dr. Eftekar (Dr. E) is the founder, head coach and lead lecturer of the medical board training programs at Northwestern Medical Review. A unique attribute of Dr. E is his well-rounded academic background that, in addition to the science of medicine, extends over several other disciplines such as physiology of aging and longevity, philosophy of science and medicine, and integrated kinesiology.

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