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Boosting immune system to fight Covid-19: Is it possible?

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By Saman Gunatilake

Emeritus Professor of Medicine

University of Sri Jayewardenepura

Immune boosting is a trending topic these days with the COVID-19 pandemic. The concept of “immune boosting” is scientifically misleading and often used to market unproven products and therapies. There is no current evidence that any product or practice will contribute to enhanced “immune boosting” protection against COVID-19. This lack of evidence has not stopped wellness gurus with vested interests, and commercial entities from propagating notions of boosting immunity. Internet and popular press are flooded with messages of this nature resulting in an abundance of misinformation circulating online. The public is increasingly going online for health information and questions persist around the kinds of inaccurate information the public is absorbing and the impacts it may be having on health-related decisions and actions.

 

What are Immunity Boosters?

Immunity boosters are products which claim to be able to support your immune system so you aren’t as likely to get sick. Additionally, if you do get sick, taking the supplements will make your illness pass faster. There is no scientific and clinical evidence in humans to support claims of ‘immunity boosting’ foods and other products which supposedly enhance immunity. The body has its own immune system which fights against viral and bacterial invaders. With a normal immune system, we are capable of protecting ourselves against most infections but with certain situations the infection manages to overcome our immune system and cause serious disease and even death. The current Covid 19 pandemic is such a situation. We are in the grip of a spike in infection with over 1000 cases per day seen during the last few days. Total deaths from the pandemic in our country is nearing 700 and the total cases up to now amounts to around 111,800.

With no scientifically established cure for Covid-19 yet and the available recommended treatments limited to severe cases and being not so effective, recovery in most cases has largely been reliant on the human body’s natural defence, the immune system. Fighting the infection by boosting our immune systems had been the buzzword since the beginning of the pandemic. This has led to many misconceptions, misinforming and misleading the public. Improving the diet, taking vitamins and herbal products, lifestyle changes are proposed as ways of doing this. As a result, the market has been flooded with an array of products that claim to boost one’s immunity.

One of the common misconceptions is that high doses vitamin supplements and other minerals and nutrients boost one’s immunity. Ayurvedic concoctions, fruit juices, vitamin pills, zinc tablets have flooded the market with an array of products that claim to boost one’s immunity. Promoters of these products indicate that the body’s natural defences can be strengthened or enhanced by the consumption of certain foods, herbal products or the use of specific products.

Is there robust scientific evidence to support these claims for immune system boosting? The answer is no. Immunology experts believe that there is no way for healthy adults to improve their immunity through foods or other products. The immune system is very complex and these claims about boosting immunity are irrational and unscientific.

 

The Immune System

The immune system is activated by things that enter the body that the body doesn’t recognise as its own such as bacteria, viruses or even particles that cause allergy, like food, drugs and pollen. Most pathogens have a surface protein on them that the immune system recognizes as foreign. These are called antigens. Then the immune system sets in motion a complex process that fights the invader – this is the immune response.

There are two kinds of immune responses in the human body. The innate immune response is the first to kick in and is common among all animals. It is non-specific and immune cells mount an immediate attack on antigens. The response is subsequently replaced by the adaptive immune response, which tailors defences based on the kind of pathogen that is being encountered. The innate immune response consists of white blood cells like neutrophils, macrophages, and monocytes, while the adaptive response involves Lymphocytes -T cells and B cells, as well as antibodies produced by these cells as a specific response to the invader’s antigens. Stimulated immune systems release chemical proteins known as pro-inflammatory cytokines in large numbers, which can cause soreness and pain. So boosting immunity may lead to unwanted inflammations causing swelling, redness and pain locally and fever and other organ damage.

The Internet searchers will find that the myth of “boosting immunity” is extremely pervasive. Of the approaches that claimed to boost immunity, the top ones were diet, fruit, vitamins, antioxidants, probiotics, minerals. Interestingly, vaccines, the only proven method that enhances our immune response to an infection is ranked very low. One of the biggest misconceptions is that consuming more vitamins than required helps the immune system. It has been proven, time and again, that mega-doses of Vitamin C or of any kind of vitamin are not effective on the body at all. Another misconception is that zinc tablets can play a role in mitigating Covid-19. However, this isn’t backed by evidence either.

Zinc is not an immunity booster. It is an essential mineral for the body which is a ‘cofactor’ for a large number of proteins and enzymes. A cofactor is a non-protein chemical compound or metallic ion that is required for an enzyme’s activity as a catalyst. Like zinc, vitamin C is also a cofactor, and is important for the body to function. So, if you have a deficiency of these essential micronutrients, you will face a problem. But, if a person does not have any such deficiency, an excess amount of these taken does not improve one’s chances of fighting off a virus. Vitamin C and Zinc deficiencies are very rare unless someone is starving or following an extreme diet depleted of nutrients. Iron and Iodine deficiencies are seen in communities and more than immune deficiency they cause other problems.

An extremely active immune system, can also be problematic. In severe Covid-19 cases, the body launches an aggressive immune response resulting in the release of a large amount of pro-inflammatory proteins. This is known as a cytokine storm and is one of the common causes of death in Covid-19 patients. A cytokine storm occurs when the body’s immune system goes into an overdrive, killing healthy cells and causing organ failures. Several research studies suggest that the cytokine storm causes lung injury and multi-organ failure. So, if this is the case boosting the immune system in a Covid patient is not a wise thing to do.

 

Market interests add to the myth

The truth is natural immunity in normal people cannot be improved. There are immunocompromised individuals with a poor immunity who are susceptible to infections due to certain illnesses, and how can they stay safe from this highly infectious virus that spreads rapidly? The most effective way is by keeping our communities safe.

 We can do this by attending to the public hygiene of the population exposed to the infection. Providing safe drinking water, providing clean air, providing adequate nutrition — are ways of keeping the people healthy and strong to fight any infections. There are parts of our country fortunately not as bad in India, without access to these basic health requirements. Achieving social distancing in these communities that live in overcrowded households is impossible.

This background, and a new infection with no treatment, led to various interested parties with good and bad intentions in promoting the myth of immune boosting. They have become self-proclaimed experts exploiting this crisis, putting forth all kinds of miraculous non allopathic substitutions. As allopathic medications to be approved, a rigorous procedure has to be observed, they resorted to the easier approach of promoting quick remedies in traditional and herbal products. Unproven ‘natural’ remedies came to the fore in our country in this background where people felt helpless. The vaccine, the only proven way of boosting the immunity of an individual and the population against a specific disease was not available around this time.

There are added dangers in such situations. There may be a lot of drug-drug interactions. If people are consuming allopathic medicines, and then also start consuming these medicinal herbs, the components of the herb will interact with the drug resulting in unknown complications. These unapproved medications can have toxic effects on your kidney, liver and other organs.

Even during the Spanish Flu pandemic in 1918 companies jumped in on the opportunity to hail themselves as immunity boosting drug producers. However, no products were ever proven to be effective in improving immune responses.

Maintaining a normal immune system

A poor immune system is seen in people with certain ailments. Some are born with defects in their immune system and they are known as immunodeficiencies. People with chronic illnesses like diabetes and auto immune disorders are also vulnerable to catch illnesses easily as their immune systems are weak. People on immunosuppressant medications like steroids and cancer drugs also have a weakened immune system and easily catch infections and develop serious complications easily.

Lifestyle is key for keeping your immune system normal and ready to act with an adequate response when necessary. For now, there are no scientifically proven direct links between lifestyle, exercise and enhanced immune function. Researchers are exploring the effects of diet, exercise and stress on the immune response. There are indeed processes that do affect our immune cells and improve their responses. The best one of them, perhaps, is exercise. Many studies have shown that moderate exercise of less than 60 minutes can improve the circulation of anti-inflammatory cytokines, neutrophils, natural killer cells, T cells and B cells. This can work effectively — not for combating diseases at a specific point in time, but to combat stress hormones in general, which can suppress immune cell function. Extremely high intensity exercise leads to a short duration of compromised immunity, increasing risk for disease in this time period. This is one of the reasons marathon runners or professional sports persons tend to catch a fever or cold in the days following a sporting event. Regular exercise is known to improve cardiovascular health, lowers blood pressure, helps control body weight. Therefore, adopting general healthy-living strategies make sense since they are likely to have other proven health benefits. But whether they help to boost the immune system is a controversial issue with no proven answers.

The immune system can also be compromised by many lifestyle habits such as smoking, which is known to affect T and B cells, among a host of other parameters. Diseases like diabetes by themselves result in compromised immune systems. This is why diabetic patients are particularly susceptible to infections. Obesity is another condition with a weak immune system as it predisposes to the development of other illnesses like diabetes and hypertension. There appears to be a connection between poor nutrition and immunity and this is a problem especially in the elderly. Poor nutrition can lead to micronutrient malnutrition, in which a person becomes deficient in some essential vitamins and trace minerals. Deficiency of these can result in a poor immune response to infections. Older people tend to eat less and often have less variety in their food. In them dietary supplements may have some beneficial effects and they should discuss this with their doctors. Taking mega doses of vitamins do not help and can even be harmful.

Every part of your body, including your immune system that fights against infections function better when protected from unwanted damage and bolstered by healthy-living styles. These are – not smoking, taking a diet high in fruit and fibre, exercising regularly, maintaining a healthy weight, avoiding alcohol or consuming in moderation, getting adequate sleep, washing hands regularly, developing good food habits, minimizing stress.

However, there currently exists no evidence of any consumable foods or products being able to induce an improvement in immune function. Although some preparations have been found to alter some components of the immune system, so far there is no evidence that they actually boost your immunity to the point where you are protected against infection. The only scientifically proven way to boost immunity, the immune system, and an immune response is through vaccinations. Vaccines prime your immune system to fight off infections before they take hold in your body.

So, where do we stand today? Vaccines to boost our immunity against Covid, prevention of spread and catching infection by proper wearing of masks, washing hands and maintaining social distance. These are the scientifically proven methods and others appear to be market-driven myths.



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Features

Eastern University and the making of a culture of peace

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by Jehan Perera

There is an important change in the way peace is being understood in Sri Lanka. The notion that peacebuilding is not simply the responsibility of governments, politicians and peace organisations, but is also a responsibility of educational institutions, appears to be permeating the consciousness of at least a section of the academic community. This was visible on International Peace Day at an event held at Eastern University by the Faculty of Health-Care Sciences. The event was unusual not least because the medical and nursing faculty of the university had decided that peacebuilding was relevant to its academic and professional responsibilities.

Peacebuilding has too often been treated as something undertaken after conflict, when the fighting has stopped and the immediate task is to rebuild relationships between communities. But peace cannot be sustained by governments and peace organisations alone. If it is to become long lasting, the values and practices of peace have to become part of the institutions through which a society educates its younger generations. Universities and other educational institutions are therefore important to peacebuilding. They are among the places where the foundations of a culture of peace can either be built or neglected.

The experience of the Faculty of Health-Care Sciences at Eastern University provides a practical example of what this can mean. Led by its Dean, Prof Thillainathan Sathaananthan, the faculty organised an event which went beyond the ordinary academic scope of a medical faculty. University academics are experts in writing project proposals and applying for research grants. On this occasion, the members of the Faculty of Health-Care Sciences used those skills to apply for a UNESCO grant that they won to conduct an International Peace Day event. The significance lies less in the Rs 200,000 grant than in the decision to use the university’s institutional capacity and resources to invest in peacebuilding. The event at Eastern University needs to be understood as more than a successful university programme. It represents a possible paradigm shift in peace thinking.

Institutional Commitment

The Peace Day event obtained the support of the university administration, including Vice Chancellor Prof P Peratheepan, and reached out to secondary schools in the vicinity to mobilise their attendance. The event itself was meticulously organised. There were cultural items including traditional and modern dance and song in the three languages, performed by combinations of solo, duet and multiple singers, dancers and actors drawn in part from nearby secondary schools. There was a panel discussion by senior academics on the general theme of peacebuilding and how to prepare for it. A discussion among the students followed, where each student spoke on behalf of a religion that was not theirs. This is significant because peacebuilding cannot remain an idea discussed by specialists at conferences. It has to become part of the way institutions educate and prepare people for life in a plural society.

The Faculty of Health-Care Sciences at Eastern University has provided a model through its Peace Medicine course modules that were introduced to the curricular as a compulsory core course over 10 years ago. Two senior academics, Dr Kuveriel Eliyas Karunakaran and Dr Thillainathan Sathaananthan, have written a book on “Peace Medicine- A Health Care Concern” that was published five years ago. Its Peace Medicine Module integrates principles of medical ethics, compassion, equity, social justice and community engagement into health education and practice. In his introduction, former Vice Chancellor of Eastern University, Prof T Jayasingam noted “This book is an introduction to a theme which had already been operating in the Faculty of Health Care Sciences as a course.”

Doctors, nurses and health workers know better than anyone the harm that war and violence does. They are the people who treat the wounds and trauma that violence leaves behind. In a hospital, a patient is not asked what their religion or ethnicity is before they are treated. Health care is one of the places where peace is practised every day. The Faculty has therefore found a way of connecting its professional responsibilities with the wider social responsibility of peacebuilding. The question is whether this experience can be replicated throughout the country, at universities and at other educational institutions, so that peacebuilding becomes part of the consciousness of education itself. If that happens on a sufficient scale, it can begin to generate a culture of peace that becomes increasingly difficult to reverse.

Local Action

The Eastern University event corresponded closely to the United Nations theme for this year’s International Day of Peace, “Invest in Peace – For Everyone, Everywhere, Every Day”, which honours the “everyday architects of peace”, people driving local action, laying the groundwork for stability and building lasting peace from the ground up. The emphasis on investment is important. An investment means that something is put in: time, courage and resources. There is no more violent conflict in Sri Lanka today. But the absence of war does not automatically produce a culture of peace. The factors that fed the country’s conflict have not disappeared from the world. Racism, corruption and the violation of laws and human rights are the raw materials of conflict. So too are unresolved grievances, discrimination and the failure to recognise the suffering of others.

A country that does not deal with its past does not escape it. The past can return in the next generation. This is why the experience of Eastern University needs to be replicated countrywide, both at universities and at other educational institutions. The objective should not be to turn every academic discipline into peace studies. Rather, peacebuilding needs to become part of the consciousness of education itself. Eastern University shows that a medical faculty can develop Peace Medicine. A law faculty can examine the relationship between justice, rights and peace. Faculties of education can prepare teachers to work in diverse communities, while the humanities and social sciences can examine the different narratives through which communities understand their histories. Every institution can find its own way of making peacebuilding relevant to what it teaches.

Sri Lanka has had many declarations, pledges and programmes in the past. What matters is whether these produce changes in behaviour and institutional practice. Peacebuilding requires confronting difficult issues rather than avoiding them. It requires respect for different identities, but also engagement across those identities. It requires dealing with grievances in the present while also addressing unresolved issues from the past. It requires truth, accountability, reparations and guarantees of non-recurrence. It requires people to learn that the rights of another community do not diminish their own rights. The International Peace Day event at Eastern University was evidence of a change in the way at least some academics in a part of the country deeply affected by war are thinking about their responsibilities. Peace needs to be invested in and the most important investment will be in the minds of those who will inherit the future.

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Quality assured education commodities

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by Ahilan Kadirgamar

I have always noticed the little paper tags that are inside the packaging of some products that say quality assured or quality control. I often wonder who might have checked the product and stamped that tag, but I also forget the tag soon enough. Decades later, when I entered academia, I was taken aback by the emphasis placed on quality assurance in our universities. It is not something that could be forgotten and done away with; the entire university system is obsessed with quality assurance.

Beginning with the staff induction programme, quality assurance is drilled into the newly recruited lecturers. It is the norm, not seen as doing any harm and only trying to improve quality. It is accepted as given, and not questioned. Quality Assurance Cells and Committees are omnipresent and hover above the Departments and, at times, even the Faculty Boards. Quality Assurance reviews are feared by the Deans and Vice Chancellors. University life itself seems secondary to the rule of quality assurance. What do we make of this system of quality assurance and what are its implications for our university system?

Corporate speak

Universities globally have been going through major changes with neoliberal education policies. In many countries, universities increasingly became corporatised to be run like businesses in the 1980s. As state support for universities declined, cost cutting became the norm. They started hiring adjunct or part-time staff. Many public non-fee levying universities around the world began to charge fees. Decade by decade, tuition fees became more and more exorbitant, forcing students to take student loans. The total student debt in the United States now stands at close to US$ 2 trillion; which is about 20 times the GDP of Sri Lanka. As the higher education landscape transformed in the West, university administrations began to recruit Presidents, Vice Chancellors and administrative officials with corporate backgrounds and experience.

Such corporatisation of universities in the West has since been imported into countries like Sri Lanka, introducing a new corporate vocabulary, including quality assurance, graduate competencies, programme outcomes, intended learning outcomes, etc. University teaching has become secondary to documenting so-called outcomes. The teacher-student relationship, the environment of the lecture hall and even administering the university have been over-determined by the processes of ensuring quality. How did such major changes come about in such a short time? Indeed, academics of just two generation ago, would never have heard of these terms and processes in the Sri Lankan university system.

World Bank Trojan horse

Since the early 2000s there have been a number of World Bank projects that have drastically changed the character of Sri Lankan universities. Quality assurance as a central agenda within universities, and many other changes to the working of our universities, came through these World Bank initiatives. The Improving Relevance and Quality of Undergraduate Education (IRQUE) project and Higher Education for the 21st Century (HETC) project were two such earlier projects that set up the Quality Assurance and Accreditation Unit (QAAU) under the University Grants Commission (UGC) and established systematic quality assurance reviews for state universities. The public often thinks these are grants from the World Bank to modernise our universities. However, they are not grants but loans.

The most recent such project, Accelerating Higher Education Expansion and Development (AHEAD) is a US$ 100 million loan from the World Bank implemented from 2018 to 2023, which consolidated the quality assurance structures from the earlier projects. Furthermore, these projects are implemented with tremendous arrogance, prioritising their implementation over all other concerns in the universities, when the project over six years for example accounts for just one fourth of our budget allocation for universities this year.

The AHEAD project drastically changed course curricula, sought to increase student enrolment in science, technology, engineering, mathematics (STEM) disciplines, commercialise the university research agenda and create university-business linkages. All of this was pushed to supposedly help us face development challenges. We have heard the ideological attack on our universities and even students claiming they are “unemployable graduates”. These changes to our higher education system were supposedly going to create jobs and increase employment.

The irony of the AHEAD project is that just as it was ending in 2023, apparently after having reached its targets, the Sri Lankan economy was collapsing. The World Bank often gets the direction of causality wrong. It is the economy that creates jobs for graduates, and not the training or kind of graduates that create jobs. It is decades of World Bank policies, and those of its ideological twin the IMF, that have led to such high youth unemployment, not only in Sri Lanka but also in many other countries in the global South.

Sri Lanka entered an IMF agreement in March 2023 and started a new Country Partnership Framework with the World Bank in June 2023. These programmes have little to say about, and actively discourage, government initiatives that aim to create an industrial policy or an employment creation policy. Instead, they push for austerity measures, which not only restrict the allocation for education among other sectors, but also end up contracting the economy to the detriment of increasing employment. Their goal is the commercialisation of higher education, to make universities into businesses and run them like factories.

In this context, the ideology of quality assurance is powerful. The International Organisation for Standardisation (ISO), whose different standards are necessary for marketing, is the institution that came up with the concept of “quality assurance”. It promoted quality assurance as a process of identifying defected products. Therefore, when the World Bank promotes this conceptual framing, our students are, in fact, seen as products on the assembly line, with quality assurance processes aiming to prevent the release of defected products from the university system. For the US$ 100 million we borrowed for the AHEAD project and the many more million dollars in similar World Bank projects, there is no evidence of increased employment of graduates.

Commodity fetishism

Over a century and a half ago, Karl Marx critiqued the economic analysis prevalent at that time that associated some inherent or monetary value for commodities without considering the social relations that underlie the production of those commodities. Marx called this commodity fetishism. Furthermore, he theorised that such commodity fetishism was also a reason for the alienation of human beings from the world. If our labour and what we produce is seen devoid of the social relations that underlie them, we lose our connection with the people and the world. In this process we become alienated from what we produce and the world.

We are now in a world where our students themselves are fetishised as commodities for the market. Universities are no longer communities concerned about knowledge and human growth, but mere factories producing commodities, which have to be produced without defects to be marketed. In this way, quality assurance has become the cause for the alienation of students, academics and our universities themselves, from the larger relationship with our economy and society.

Our university system does need reform. It is grossly underfunded and not providing the financial support and facilities for our students. Universities have become hierarchical spaces without the academic freedom and democratic ethos necessary for producing knowledge. Academics and students need to engage more with their communities to make their learning and research meaningful, not to mention their contribution to and integration with society. However, when it comes to even questions of governance and regulation of the universities, such concerns are merely reduced to improving quality. In our contemporary times, this singular focus on quality assurance, as opposed to addressing the larger structural issues, is crippling our universities. There may be no way out, but to put back quality assurance where it started, those little tags on goods, to perhaps be noticed but quickly forgotten.

Ahilan Kadirgamar is a political economist and Senior Lecturer, University of Jaffna.

(Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies)

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Features

Thailand’s biggest new global star …

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The entertainment scene, globally, is agog with excitement, and, why not!

Yes, a new global star has emerged … from Thailand, and she hit the headlines by winning America’s Got Talent.

Rattikarn Amloy, known to millions by her stage name Nene Royal, was crowned the winner of America’s Got Talent (AGT) Season 21 at the live finale at Pasadena Civic Auditorium, California, taking home the USD 1 million grand prize.

The 16-year-old rocker, from the holiday island of Phuket (I’ve been to Phuket, courtesy Tourism Authority of Thailand), has struck a power chord around the world, and is the first Thai national ever to win the hit NBC show.

She beat nine other finalists, including runner-up magician Geno Ploeger, after a blistering final performance.

Nene’s story is pure rock and roll fairy-tale. She says she picked up a guitar at age seven, fell in love at the first chord, and taught herself mostly by watching videos online. That dedication earned her a music scholarship to Kajonkiet International School Phuket.

Her audition at America’s Got Talent — a swaggering, shredding rendition of The Cranberries’ classic ‘Zombie’ — exploded online, amassing over 200 million views across AGT’s platforms, more than any act this season.

She kept wowing: ‘Hysteria’ by Muse, then ‘Black Hole Sun’ by Soundgarden which earned her Spice Girl Mel B’s Golden Buzzer, sending her straight to the live shows.

For the final, she unleashed ‘Seven Nation Army’ by The White Stripes. Judge Howie Mandel shouted: “You should win. Give her the million, America.” Mel B praised her “mysterious, mystical stage presence”.

And for the grand finale, she lived every teen rocker’s dream — performing on stage, alongside US rock giants Linkin Park.

When host Terry Crews announced her as winner, the teenager collapsed to the stage floor in tears. “I’m very happy and you know I’m emotional right now,” she said.

And Thailand erupted. Her school held watch parties, posting: “You did it, congratulations, champion. We are so proud of you.”

Even Prime Minister Anutin Charnvirakul sent a personal congratulation. He had earlier hosted Nene at Government House in July, where she played guitar while he sang a Thai rock song. His office said her talent “brought pride to Thai people.”

Corporate Thailand also rallied behind her — Charoen Pokphand Foods, owned by billionaire Dhanin Chearavanont, even rented a giant billboard in Times Square, New York, to cheer her on.

With her blistering guitar solos, rock-ballad shrieks and fearless spirit, little Nene Royal has just become Thailand’s biggest new global star.

What’s more, this amazing teenager will be bringing her powerful vocals, guitar skills and signature rock-metal style to the stage, as opening act, before one of the world’s biggest rock bands, America’s Avenged Sevenfold, in Singapore, on 13 October.

Unfortunately, we are still to see a local artiste, grab the spotlight, on a global scale … like Thailand’s Nene.

Yes, they do shine, but mostly on social media, and that, too, with the aid of AI (Artificial Intellegence).

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