Concerned about the spread of new COVID-19 variants worldwide, medical experts, including the Nigeria Centre for Disease Control (NCDC) have made recommendations on how to contain the ‘pandemic’.
Top on the list are intensive fasting, optimal hygiene, testing and vaccination.
In a recent study published in the journal Immunity & Ageing, a group of researchers investigated the impact of short-term intensive fasting (STIF) on the immune function of red blood cells (RBCs) and their capacity to combat infectious pathogens, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that causes COVID-19.
RBCs primarily transport oxygen and possess immune functions; while immature RBCs in newborns suppress immunity, mature ones in adults utilize the complement system to defend against pathogens and capture immune complexes for macrophage elimination. Recent studies demonstrate RBCs’ immune activity throughout human life.
Fasting, especially the STIF or ‘beego’ regimen popular in Asia, which combines water-only fasting with psychological exercises and concludes with refeeding, reshapes the immune landscape by redistributing cells. Further research is necessary to understand how short-term intensive fasting affects the immune response of red blood cells to infectious pathogens, especially SARS-CoV-2.
The study embarked on an exploration of the impact of STIF on red blood cells. This was conducted on thirty-one subjects who practiced STIF for six days, followed by a six-day refeeding period, a method popular among water-only fasting participants in Asia. The research procured proteomics profiles of red blood cells from a subset of the cohort. The differential analysis revealed significant variations in protein abundance throughout the fasting and refeeding stages.
During the intensive fasting and refeeding process, biological pathways were analyzed, revealing that by the sixth day of fasting, numerous immune response-related pathways were activated, many of which persisted through the sixth day of refeeding. By integrating differential expression analysis with gene set enrichment analysis (GSEA), the researchers established that STIF appears to promote the immune function of red blood cells. This was further solidified by flow cytometric analysis, which indicated an increase in the expression of a protein associated with enhanced immune response in red blood cells.
An in-depth GSEA of the proteome profile in connection with the KEGG database disclosed that STIF significantly impacts how red blood cells respond to pathogens. This became especially intriguing when it was noted that STIF not only activated immune responses against various pathogens but also had a prolonged effect on coronavirus disease (COVID-19).
Further exploration revealed that a significant portion of the enhanced immune response was linked to the complement system, which is vital in mature red blood cells for defense against pathogens. The evidence proposed that STIF activates this system, thereby enhancing the immune function of erythrocytes. Particularly noteworthy was the finding that post-STIF, red blood cells were primed to combat SARS-CoV-2.
However, given that red blood cells primarily transport oxygen, the team questioned whether boosting the immune response might compromise this primary function. Various tests confirmed that the primary function remained intact, with no noticeable changes in the red blood cells’ morphology, size, or oxygen-carrying capacity.
Lastly, the viability of the red blood cells during and post-STIF was explored, as overactivation of the complement system can sometimes induce apoptosis. However, results showed no change in the apoptosis levels during STIF, suggesting that the activation of the complement system did not hamper erythrocyte viability. In essence, this study unveiled the multifaceted benefits of STIF on red blood cells, enhancing their immune response without compromising their primary function or viability.
To summarise, in the present study, researchers discovered that STIF amplifies the immune response of human red blood cells against SARS-CoV-2 without compromising their oxygen transport ability, and this enhanced immunity persisted through extended fasting and refeeding periods. Past research showed fasting’s impact on leukocyte immune functions, but the effects on human red blood cells were unclear.
The study indicates that red blood cells enhance defenses during leukocyte shortages, especially in their immune reaction to SARS-CoV-2 due to their interactions with the virus in COVID-19 patients; however, further research is essential to comprehend the long-term implications fully.
Meanwhile, Director General, NCDC, Dr. Ifedayo Morayo Adetifa, and the Executive Director of National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib, have urged Nigerians to continue observing all COVID-19 protocols and get vaccinated.
Adetifa told The Guardian: “We continue to see positive COVID-19 test results among people with respiratory/flu symptoms who are ill but this has not shown any increase or worrying trend.”
Adetifa, who is also a public health physician, said regardless of what is trending in the media or headlines, the NCDC as an agency of the Federal Ministry of Health (FMOH) continues to conduct surveillance for all diseases of public health importance in collaboration with State Public Health authorities.
He said while COVID-19 reports are no longer reported with the same frequency as before given the de-escalation in response, surveillance continues to keep track of trends and circulating variants.
To keep the virus in check, the NCDC boss recommends: “Our recommendations have not changed. We continue to encourage vaccination especially for high risk populations. Self-risk assessment and adherence to public health safety measures – hand washing, mask use and avoiding overcrowding – as may be indicated. Those who are ill should ask for a COVID-19 test regardless of symptomatology and particularly with respiratory symptoms.”
Meanwhile, Director General of Nigerian Institute for Medical Research (NIMR), Prof. Babatunde Salako, said they are set to start receiving samples for testing.
On where one can go for COVID-19 test, Salako said: “I am sure the NCDC laboratories should be ready for testing at any time. I am sure all hands are on deck to forestall any large outbreak. The recent experience has remained with us and we will not be starting from ground zero.”
On what Nigerians should do, Salako said: “Again, Nigerians are also well experienced in combating the disease so we should only remind them of what they already know. More importantly is the fact that this current variant does not behave like the last few ones. Attention should therefore be paid to body pains, sore throat, headaches and evidence of pneumonia. People should visit their physicians early if they notice any of the above. We should remember social distancing, regular hand washing, use of masks especially in suspected cases and avoid crowded places. Most importantly, vaccination is still ongoing and people should key into it.”
A foremost virologist and the pioneer Vice Chancellor of Redeemer’s University, Prof. Oyewale Tomori, said Nigeria needs to enhance her surveillance, especially at international borders, since the new variants, if they are not already established here, will be brought in by passengers coming from the countries where the variants are already present
“We must provide our laboratories with adequate quantities of diagnostic kits, and other supplies, so we can not only resume testing but also, continue testing for as long as COVID-19 is reported in any part of the world.
“We must continue to inform and alert our healthcare providers and the community to the current situation of COVID-19 in other parts of the world and encourage our people to take appropriate precautions.
“I do not see us going back to the strict non-pharmaceutical intervention requirements of the past, but we must wait to see how the new COVID-19 virus will act. The waiting must not be too long. This is why we should improve and upgrade our surveillance to a higher level, and increase lab testing, as appropriate,” he said.
The virologist said nothing is safer than getting vaccinated. He said there seems to be a quiet abandonment of the COVID-19 vaccination plan and Nigeria needs to have more people vaccinated. We must continue to be wary and be prepared for COVID-19. “It has not left; it is still around, and this is one heck of a smart virus. We disdain it at our peril,” Tomori said.
