THEORETICAL APPROACH TO THE ARRIVING INFECTIOUS PANDEMICS
Jose C. Meeroff Clinical
Associate Professor of Integrated Medical Sciences; Director Florida Institute
for Integrative Medicine and
Daniel E. Meeroff Professor and Associate Chair Florida
Atlantic University, College of Engineering and Computer Science Department of
Civil, Environmental & Geomatics Engineering
A FEW QUOTATIONS FROM DIFFERENT BACKGROUNDS THAT ARE RELEVANT TO THE
ISSUE
ü “Almost
no germ is unconditionally dangerous to man; its disease-producing ability
depends upon the body's resistance” Hans
Seyle
ü “You
should work to live, not live to work”
Hans Seyle
ü “In the long history of
humankind (and animal kind, too) those who learned to collaborate and improvise
most effectively have prevailed” Charles
Darwin
ü “It
is not the strongest of the species that survives nor the most intelligent, it
is the one that is the most adaptable to change” Charles Darwin
ü “Life
is like riding a bicycle. To keep your balance, you must keep moving” Albert
Einstein
ü “Every scientist becomes
convinced that the laws of nature manifest the existence of a spirit vastly
superior to that of men.” Albert Einstein
ü “When
in doubt, attack” George S Patton
ü “Prepare
for the unknown by studying how others in the past have coped with the unforeseeable
and the unpredictable” George S. Patton
ü “Luck is what happens when preparation meets
opportunity”. Seneca the Younger
ü “It
does not matter who does this job or that as long as there is someone to do
it” Ervin Laszlo
ü “
Progress cannot lie in more and bigger; it must be redefined, and that means
having a new system of values” Ervin
Laszlo
ü “If
you are not ready to beat the enemy because your opponent is stronger than you
are, first join and cooperate with them to learn how they operate and function,
and later try to defeat them” JC Meeroff
ü “Complexity
is relatively simple when you understand it”
JC Meeroff
INTRODUCTION
For the last centuries our civilization has been living under a
contemporary cybernetic bureaucratic industrial paradigm with the aim of
conquering nature, subduing it, exploiting it, raping it, and destroying it ( E.
Fromm). A bureaucratic structure is based on fixed role assignments, and
explicit work descriptions. It decreases
society’s ability to adapt to changes and give preference to preserve the
structure/organization rather than to protect the individuals (Hirst). Bureaucracy
is antinatural since it undermines creativity,
inhibits risk taking, and crushes innovation.
Concerned people of all avenues of life (scientists, philosophers, artists, politicians, economists, psychologists,
physicians, entrepreneurs, teachers, etc.) warned us for decades of the ill consequences
of accepting such paradigm as dogma. We didn’t listen or if we listen, we
didn’t pay much attention to the recommendations and we didn’t act. For example,
it is fair to say that modern society didn’t learn much from the 1918 Influenza
pandemic. After the poorly handled “Spanish” influenza, western society entered
the ludicrous roaring 20’s with uncontrolled consumerism and empty materialism,
social inequality and racism, leading to the great depression and to WWII.
Suddenly, but not unexpectedly, in 2020, the COVID-19 pandemic afflicted
us badly. It, over again, brought the hallucination of the end of our
civilization. It will probably be just another nightmare, but the COVID-19
pandemic unveiled the colossal errors our contemporary society has been
committing and the imperious need for drastic changes if we want to survive and
strive.
The issue is not just to realize that we need to implement changes, the
issue is that if, this time, we don’t act swiftly, we will unavoidably witness
the end of the highly conscious human civilization (Homo sapiens). This time we
must affront the battle of quality vs quantity. Viruses strive by multiplying
exponentially and irrationally, while humans must struggle by acting
intelligently and efficiently since It appears that species who have a high
rate of metabolism and multiply excessively get extinct sooner (Niitepõld).
Therefore, humans must modify their approach to life and create balanced, thoughtful
communities based on responsibility, education, ethics, love and sense of
purpose. We must slow down and wait for the storm to pass by but, at the same
time, be actively prepared for the next one to come.
Again, as it happened in 1918, science is “confronting nature, while
society began to confront the effects of nature. To have any chance in
alleviating the devastation society requires organization, coordination and proper
implementation. It necessitates leadership and institutions who follow that
leadership” (Barry).
“The proto sciences of antiquity
sought to penetrate the complexities of phenomena by insight and/or revelation.
Their theories were imaginative and sometimes inspired, but they could seldom
stand the test of confrontation with actual experience” (Laszlo). Modern, pre-contemporary
sciences (mechanistic sciences) offered practicality since they handled very
efficiently relatively simple things. Nevertheless, they felt short when trying
to explain life as we live it. More than a century ago after Einstein and
others introduced relativism and quantum physics, science began to view things
differently. They understood that things are not as simple as we thought. Von
Bertalanffy introduced the Systems Theory (ST), a theory contrary to reductionism
that is the prevailing materialistic theory . Reductionism implicates that every
complex phenomenon, especially in biology or psychology, can be explained by
analyzing the simplest, most basic physical mechanisms that are in operation
during the phenomenon. ST emphasizes the need for the unity of all sciences in
order to comprehend complexity. Rather than reducing an entity such as the
human body to the properties of its parts or elements (e.g. organs or cells), ST
focuses on the arrangement of and relations between the parts which connect
them into a whole (Von Bertalanffy ).
To follow contemporary science, in Medicine, we adopted the Integrative Model
(IMOM = integrative model of medicine) that brings a new pragmatic, neo-dualist
paradigm better suited to understand the health problems of today (Meeroff JC).
IMOM recognizes the human being as a
complex natural system. “We are natural systems first, living things second,
human beings third, members of a society and culture fourth and particular
individuals fifth” (Laszlo). , According to IMOM, life can be understood
as balance in motion (Meeroff JC). During
life, human beings live in “a potentially hostile environment and it must guard
against inputs which may inflict damage upon its delicate balanced components”
(Laszlo). We are constantly facing impose demands (stress). Stress produces
positive as well as negative after-effects. Stress is associated with all types
of loads and we ought to reduce and/or avoid the ones causing distress (bad
stress) and keep the ones that generate eustress (good stress). Distress comes
in many shapes and forms, but they have common characteristics: the imposing
demands of distress are too strong, arrive too soon and/or they are too
prolonged. The responses to distressing loads depend on the system codes characteristic
of each individual. Examples of distress are many and well known. We like to refer frequently to the one that comes
with gerascophobia (abnormal or incessant fear of growing older) and ageism (prejudice
or discrimination on the grounds of a person's age) because is self-created and
avoidable: “The continuous leisure of
enforced retirement or solitary confinement is certainly not an attractive way
of living, nor a healthy one. It leads to imbalance and ultimately to death.” (Seyle)
In line with the ST, health (wellness) can be defined as a state of dynamic
balance leading to a stable bio-psycho-social condition of well-being and to a
harmonious interconnectedness of the person with the environment, with nature
and with the universe. Health is keeping a relatively steady state and the harmonious
functioning of both the material and the immaterial aspects of life (Saracci).
Disease (unwellness) represents a
deviation from the somatic, psychological, social, and spiritual dynamic healthy
balance. Disease is a multifactorial process that occurs when the individual is
incapable of handling demands (distress, overload). Distress may not
necessarily be psychological. It can also be environmental and/or physical.
Moreover, most distress leading to disease is a combination of multiple
components (Meeroff S).
ST is certainly dense and more difficult to be grasped than reductionism.
Consequently, up to now, we stayed stagnant and remained attached to simplistic,
materialistic mechanistic sciences
ignoring the signs and symptoms caused by such sightlessness. As a result, unhappiness,
misery, overpopulation and pandemics came along.
The COVID-19 pandemic is an example of diseases caused by infectious
agents. The COVID pandemic is not much different of the “Spanish” Influenza
pandemic of last century, although it may be more virulent and/or prolonged.
Infectious diseases occur when the human body is assaulted by unfriendly
microbes. Infectious diseases are transmitted from person to person by
direct or indirect contact.
Direct contact
ü Person to
person contact
ü Droplet
spread
Indirect contact
ü Airborne
transmission
ü Contaminated
objects
ü Infected food
and drinking water
ü Animal-to-person
contact
ü Insect bites
(vector-borne disease)
As
for outbreaks of transmission of respiratory viral diseases such as influenza
and corona viruses, “any environment that is enclosed with poor air circulation
and high density of people (from ships and airplanes to stadiums and
classrooms), spells trouble. Coughing, sneezing, breathing, even talking will
release respiratory droplets that can travel some distances and stay airborne
for a few minutes and can infect other people staying in the vicinity”
(Bromage)
A FEW IMPORTANT DEFINITIONS RELATED TO INFECCIOUS DISEASES
ü Infectious
diseases: disorders caused by pathogenic organisms (germs/microbes/bugs) such
as bacteria, viruses, fungi or parasites. The diseases can be spread, directly
or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals
that can cause disease when transmitted to humans.
ü Antigens:
Any substance (such as microbes or toxins) foreign to the
body that evokes an immune response either alone or after forming a complex
with a larger molecule (such as a protein) and that is capable of binding with
a product (such as an antibody or T cell) of the immune response.
ü Antibodies:
A blood protein produced in response to an invasion of
antigens to counteract such invasion, Antibodies combine chemically with
substances which the body recognizes as alien, such as bacteria, viruses, and
foreign substances in the blood.
ü Susceptibility:
Being likely or liable to be influenced or harmed by unfriendly microbes
ü Vulnerability:
Capability of a susceptible species to be affected by unfriendly microbes
ü Asepsis: Absence of microorganisms responsible for producing septic
diseases (local or generalized invasion of the body by pathogenic microorganisms
or their toxins)
ü Mitigation: The effort to reduce losses (disease, death) by lessening
the impact of disasters. In order for mitigation to be effective it is
necessary to take action before the next disaster. It is important to know that disasters can
happen at any time and any place and if we are not prepared, consequences can
be fatal.
ü Adaptation: Any change in the structure or behavior of a species which
helps it to become better fitted to survive and reproduce in its environment.
Adaptation can be accomplished by symbiosis and/or by mutation
ü Symbiosis: Interaction between two different organisms living in close
physical association, typically to the advantage of both (mutualism)
ü Mutation: Changes in the structure of a gene, resulting in a variant
form that may be transmitted to subsequent generations, caused by the
alteration of single base units in DNA, or the deletion, insertion, or
rearrangement of larger sections of genes or chromosomes.
ü Phylogenesis: The process by which complex systems, such as humans,
evolve to manage their instability by buffering out the forces threatening to
change their structure in a radical fashion. Furthermore, within the super
systems, organic systems may combine to facilitate mutual evolution. (Laszlo)
THE IMMUNE RESPONSE
The human immune system (IS) is a vital system designed to fight
infections. The IS is physically located in many tissues of the host (body).They
include most importantly the bone marrow, the thymus gland, the spleen, the
liver and the gut. The gut walls store about 70 percent of the cells that make
up the IS.
The IS has evolved to protect the host from a myriad of pathogenic
microbes that are themselves constantly evolving. The IS also helps the host
eliminate toxic and/or allergenic substances that enter through mucosal
surfaces. Central to the IS ability to mobilize a response to defend against an
invading pathogen, toxin or allergen is its ability to distinguish self
(natural component of the body) from non-self (pathogen invaders, antigens).
There are two major subsystems of the IS: the innate IS (you are born with
it) and the adaptive IS (you develop it by specific stimuli such as
vaccination). Both of these mechanisms include self/non-self perception. Both
subsystems use humoral immunity and cell-mediated immunity to perform
their functions.
Under normal conditions, the immune response goes through 4 non-linear phases
1. Latent or Lag
phase: Following the first exposure to a foreign antigen, a lag phase occurs in
which no antibody is produced but activated B cells are differentiating
into plasma cells.
2. Exponential or log phase: In this phase the antibody concentration increases exponentially
as the B cells that were stimulated by the antigen differentiate into plasma
cells who produce antibodies.
3. Steady state phase: In this phase, the production of antibodies
reaches a plateau
4. Decline or decay phase: Here, no new antibodies are produced because the antigen is no
longer present to activate T and B cells and the residual antibodies are slowly
degraded.
We can say that the immune
response per se occur in four stages:
1. pathogen
recognition by cells of the innate immune system, with cytokine
release, complement activation and phagocytosis of antigens
2. acute
inflammatory response to contain the infection
3. activation of
specific T helper cells
4. CD4
helper T cells then co-ordinate a targeted antigen-specific
immune response involving two adaptive cell systems: humoral
immunity from B cells and antibodies,
and cell-mediated immunity from cytotoxic CD8 T cells
In general terms, the IS can work as:
A normally = adequate response;
B inefficiently = poor response or
C excessively = disproportional response
The so-called runaway immune response, (cytokine release syndrome, or a
cytokine storm), a process that may be important in determine mortality in
COVID-19 pathogenesis, occurs when the patient’s IS ramp up the
production of inflammation-driving cytokines to dangerously high levels that
results in the indiscriminative attack
of not only the invaders but also their own tissues.
LIFE ON EARTH
The human body is a fantastic combination of human cells and microbes. Humans
can see the tissues and organs but very rarely we can see “our own ” microbes. In
terms of diversity, a very conservative estimation indicates that
there are more than 1.5 million animal species on Earth some of which are
microbes.
“We ourselves, are composed of some five octillion atoms (a number so
large that is almost impossible to imagine), and our brains, of ten thousand
million neurons”. (Laszlo)
Nevertheless, the point here is that our biosphere is the home of an
enormous number of competing species. In these conditions it seems very
unlikely that our species (Homo Sapiens) can simply eradicate all other live
structures in order to survive and expand. Therefore, it is more plausible to consider
that it is necessary to adapt and develop cooperative actions to reach the
survival goal (Darwin).
Actually, scientific data indicates that the human body has about 10
times more microbial cells than human cells. Microbes are all
over our skin, hair, and also inside the body. But only a few species are dangerous. The “bad”
microbes invade the body and cause tissue damage mostly to use human material
for their reproduction and multiplication. Nevertheless, most of the germs are “good”
microbes, and without their presence, life on earth will be be impossible. Gut bacteria, such as those from the
genera Bifidobacterium and Lactobacillus, account for a large
majority of the 100 trillion “creepy crawlies” that call our body home. There,
they help to digest substances that the human body cannot break down,
like fatty acids and carbohydrates.
Bacteria are essential to protect the environment. They do the following:
·
Recycle efficiently: Bacteria play a
critical role in the decomposition of organic matter in soil and in the oceans.
They also reprocess chemical elements such as carbon and nitrogen, which are
essential for humans to survive.
·
Asist in the metabolism of nitrogen
nutrients: The soil cyanobacteria play a crucial role in turning atmospheric
nitrogen into ammonium or nitrates that plants can absorb to create amino acids
and nucleic acids, the building blocks of DNA. Then we, humans, eat the plants
and get all the benefits. Also bacteria like, Clostridium, Azotobacter, etc. fix free nitrogen of the
soil and make it available to plants.
·
Help maintaining the living cycle of nature:
They play a crucial role in building nutrients, i.e. recycling carbon,
phosphorus, nitrogen, and sulfur between human beings and the environment.
Without these cycles, there would be no exchange of elements to form organic
matter.
·
Recover water: bacteria participate in the
process that cause clouds to precipitate
producing snow and rain.
·
Combat pollution : Some microorganisms are
capable of digesting toxic substances (heavy metals, synthetic organic
chemicals ) and convert them into less harmful substances.
Microbes, especially bacteria are essential to protect human health.
They do the following:
·
Aid food digestion: They help break
down food like plant and fibers that we can’t digest on our own. Lactobacillus helps
break down sugars.
·
Allow proper absorption of vitamins:
Vitamins such as biotin, vitamin B12 and Vitamin K need bacteria to be properly
absorbed into the blood circulation.
·
Keep harmful bacteria away: Many
bacteria that live inside the mouth, throat, nose and intestines do not let
other harmful microorganisms live inside or on the human body. Bacteria in the
intestines work with the immune system to protect the body against various
diseases. Bacteria residing in the stomach helps maintain the level of gastric
acidity..
·
Safeguard our skin: The forest of
bacteria on our skin (almost 200 different species on a normal person) controls
the environment of the skin and its resources, keeping harmful bacteria away.
·
Fortify our IS: Exposure to bacteria
proved to be an important part of the development of our IS. Bacteria “train” the
IS so it become more effective to fight the harmful viruses later in life.
Children who are sheltered from bacteria are prone to develop asthma, allergies,
inflammatory bowel disease and other pathologies.
Apart from the importance of microorganisms in
maintaining health, they also have multiple roles in Medicine and Agriculture.
Bacteria are already used extensively in the production of antibiotics and
vaccines, genetic engineering, bio-pesticides, organic manure, etc. Bacteria
also prove to be very useful in industries such as cheese-making,
vinegar-making, tea curing, leather tanning, and much more. We must remember
that not all the microbes are “enemies”. We also must realize that diets high
in animal protein, processed foods, and especially flours and simple sugars
tend to raise the population of potentially harmful bacteria. Additionally,
symbiotic good bacteria spend their days destroying their harmful cousins,
picking through undigested leftovers and micromanaging calories
As it is the case for bacteria, not all viruses are treacherous. We know
that many bacteria act as parasitic pathogens ( parasitism) but some are just using
the elements of another organism without causing harm (commensalism,
inquilinism) and some are togheter for mutual benefit (mutualism). A similar
situation may occur with viruses. This area of knowledge is still at its
infancy and further research is needed to understand its role in human health (Roossinck).
THE POTENTIAL SOLUTIONS
To start
entertaining feasible solutions to future infectious diseases such as the
COVID-19 we first must recognize that it will be almost impossible to totally
conquer and destroy all the “enemies”.
Based on our current limited level of knowledge we have identified
several potential lines of defense against future infectious diseases capable
of causing endemics and pandemics.
A Short term responses
1 Reduce face-to-face contact to
decrease the spread of unfriendly microbes among people in community settings.
(Social or physical distancing)
2 Wear cloth face
coverings to protect the nose and mouth in the community setting to reduce the
spread of respiratory virus such as the COVID-19 (face isolation)
3 Eliminate hand shaking and chic social kissing to
reduce unsolicited passing of dangerous microbes among people to fight
transmission of germs (change social etiquette routines)
4 Destroy the offending microbes outside of the body: Sustain public
sanitation and vector control (external antisepsis)
5 Improve personal and global hygiene and sanitation using biocides to
kill the offending microbes outside of the body (decontamination)
6 Develop remedies to kill the offending microbes inside the body (internal
antisepsis, antibiotics, and antivirals)
7 Improve the development of natural defenses (homeostatic immunity)
8 Vaccinate to induce the production of antibodies against the particular
microbe (heterostatic immunity)
9 Control the overreaction of the immune system (stabilize the immune
response)
B Long term responses
1 Adjust and interact with microbes to produce a mutually beneficious
action (Adaptation, mutualistic symbiosis)
2 Transform to become resistant to the invader (Mutation, phylogenesis)
Unfortunately, we are ill prepared to take some of those actions immediately.
Therefore, we will unavoidable suffer the consequences of such deficit. But, in
the meantime we will need the world to investigate new ways of behavior, study, work, social life and to
always keep a safe distance from each other (Rifkin). We can’t go back to the
old “normality”; instead we must change to reach a new balanced situation.
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