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What happens in our body when we encounter and fight off a virus like the flu, SARS-CoV-2 or RSV?

<p><em><a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><a href="https://www.labcorp.com/coronavirus-disease-covid-19/covid-news-education/covid-19-vs-flu-vs-rsv-how-tell-difference">Respiratory viruses</a> like influenza virus (flu), SARS-CoV-2 (which causes COVID) and respiratory syncytial virus (RSV) can make us sick by infecting our respiratory system, including the nose, upper airways and lungs.</p> <p>They spread from person to person through respiratory droplets when someone coughs, sneezes, or talks and can cause death in serious cases.</p> <p>But what happens in our body when we first encounter these viruses? Our immune system uses a number of strategies to fight off viral infections. Let’s look at how it does this.</p> <h2>First line of defence</h2> <p>When we encounter respiratory viruses, the <a href="https://www.sciencedirect.com/science/article/pii/S193131281600038X?via%3Dihub/">first line of defence</a> is the physical and chemical barriers in our nose, upper airways, and lungs. Barriers like the mucus lining and hair-like structures on the surface of cells, work together to trap and remove viruses before they can reach deeper into our respiratory system.</p> <p>Our defence also includes our behaviours such as coughing or sneezing. When we blow our nose, the mucus, viruses, and any other pathogens that are caught within it are expelled.</p> <p>But sometimes, viruses manage to evade these initial barriers and sneak into our respiratory system. This activates the cells of our innate immune system.</p> <h2>Patrolling for potential invaders</h2> <p>While our acquired immune system develops over time, our innate immune system is present at birth. It generates “non-specific” immunity by identifying what’s foreign. The cells of innate immunity act like a patrol system, searching for any invaders. These innate cells patrol almost every part of our body, from our skin to our nose, lungs and even internal organs.</p> <p>Our respiratory system has different type of innate cells such – as macrophages, neutrophils and natural killer cells – which patrol in our body looking for intruders. If they recognise anything foreign, in this case a virus, they will initiate an attack response.</p> <p>Each cell type plays a slightly different role. Macrophages, for example, will not only engulf and digest viruses (phagocytosis) but also release a cocktail of different molecules (cytokines) that will warn and recruit other cells to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cmi.12580">fight against the danger</a>.</p> <p>In the meantime, natural killer cells, aptly named, attack infected cells, and stop viruses from multiplying and <a href="https://www.nature.com/articles/s41577-021-00558-3">invading our body further</a>.</p> <p>Natural killer cells also promote inflammation, a <a href="https://www.hindawi.com/journals/jir/2018/1467538/">crucial part of the immune response</a>. It helps to recruit more immune cells to the site of infection, enhances blood flow, and increases the permeability of blood vessels, allowing immune cells to reach the infected tissues. At this stage, our immune system is fighting a war against viruses and the result can cause inflammation, fevers, coughs and congestion.</p> <h2>Launching a specific attack</h2> <p>As the innate immune response begins, another branch of the immune system called the adaptive immune system is <a href="https://www.ncbi.nlm.nih.gov/books/NBK21070/">activated</a>.</p> <p>The adaptive immune system is more specific than the innate immune system, and it decides on the correct tools and strategy to fight off the viral invaders. This system plays a vital role in eliminating the virus and providing long-term protection against future infections.</p> <p>Specialised cells called T cells and B cells are key players in acquired immunity.</p> <p>T cells (specifically, helper T cells and cytotoxic T cells) recognise viral proteins on the surface of infected cells:</p> <ul> <li> <p>helper T cells release molecules that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764486/">further activate immune cells</a></p> </li> <li> <p>cytotoxic T cells directly kill infected cells with a very great precision, <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2018.00678/full">avoiding any healthy cells around</a>.</p> </li> </ul> <p>B cells produce antibodies, which are proteins that can bind to viruses, neutralise them, and mark them for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7247032/">destruction by other immune cells</a>.</p> <p>B cells are a critical part of memory in our immune system. They will remember what happened and won’t forget for years. When the same virus attacks again, B cells will be ready to fight it off and will neutralise it faster and better.</p> <p>Thanks to the adaptive immune system, vaccines for respiratory viruses such as the COVID mRNA vaccine keep us protected from <a href="https://www.health.gov.au/our-work/covid-19-vaccines/our-vaccines/how-they-work">being sick or severely ill</a>. However, if the same virus became mutated, our immune system will act as if it was a new virus and will have to fight in a war again.</p> <h2>Neutralising the threat</h2> <p>As the immune response progresses, the combined efforts of the innate and adaptive immune systems helps control the virus. Infected cells are cleared, and the virus is neutralised and eliminated from the body.</p> <p>As the infection subsides, symptoms gradually improve, and we begin to feel better and to recover.</p> <p>But recovery varies depending on the specific virus and us as individuals. Some respiratory viruses, like rhinoviruses which cause the common cold, may cause relatively mild symptoms and a quick recovery. Others, like the flu, SARS-CoV-2 or severe cases of RSV, may lead to more severe symptoms and a longer recovery time.</p> <p>Some viruses are very strong and too fast sometimes so that our immune system does not have the time to develop a proper immune response to fight them off. <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207023/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/lara-herrero-1166059">Lara Herrero</a>, Research Leader in Virology and Infectious Disease, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a> and <a href="https://theconversation.com/profiles/wesley-freppel-1408971">Wesley Freppel</a>, Research Fellow, Institute for Glycomics, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-in-our-body-when-we-encounter-and-fight-off-a-virus-like-the-flu-sars-cov-2-or-rsv-207023">original article</a>.</em></p>

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How contagious is the Wuhan coronavirus and can you spread it before symptoms start?

<p>Cases of the Wuhan coronavirus have increased dramatically over the past week, prompting concerns about how contagious the virus is and how it spreads.</p> <p>According to the <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports">World Health Organisation</a>, 16-21% of people with the virus in China became severely ill and 2-3% of those infected have died.</p> <p>A key factor that influences transmission is whether the virus can spread in the absence of symptoms – either during the incubation period (the days before people become visibly ill) or in people who never get sick.</p> <p>On Sunday, <a href="https://www.bbc.com/news/world-asia-china-51254523">Chinese officials said</a> transmission had occurred during the incubation period.</p> <p>So what does the evidence tell us so far?</p> <p><strong>Can you transmit it before you get symptoms?</strong></p> <p>Influenza is the <a href="https://www.infectiousdiseaseadvisor.com/home/topics/respiratory/influenza/transfluas-study-asymptomatic-influenza-transmission-in-acute-health-care/">classic example</a> of a virus that can spread when people have no symptoms at all.</p> <p>In contrast, people with <a href="https://www.nhs.uk/conditions/sars/">SARS</a> (severe acute respiratory syndrome) only spread the virus when they had symptoms.</p> <p>No published scientific data are available to support China’s claim transmission of the Wuhan coronavirus occurred during the incubation period.</p> <p>However, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30154-9/fulltext">one study published in the Lancet medical journal showed</a> children may be shedding (or transmitting) the virus while asymptomatic. The researchers found one child in an infected family had no symptoms but a chest CT scan revealed he had pneumonia and his test for the virus came back positive.</p> <p>This is different to transmission in the incubation period, as the child never got ill, but it suggests it’s possible for children and young people to be infectious without having any symptoms.</p> <p>This is a concern because if someone gets sick, you want to be able to identify them and track their contacts. If someone transmits the virus but never gets sick, they may not be on the radar at all.</p> <p>It also makes airport screening less useful because people who are infectious but don’t have symptoms would not be detected.</p> <p><strong>How infectious is it?</strong></p> <p>The Wuhan coronavirus epidemic began when people exposed to an <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext">unknown source at a seafood market</a> in Wuhan began falling ill in early December.</p> <p>Cases remained below 50 to 60 in total until around January 20, when numbers surged. There have now been <a href="https://flutrackers.com/forum/forum/-2019-ncov-new-coronavirus/823378-2019-ncov-confirmed-case-list-by-country-w-links-to-sources-total-cases-4-576-total-deaths-106-as-of-9-40-et-january-27-2020-disclaimer-we-do-not-endorse-any-of-these-numbers">more than 4,500 cases – mostly in China – and 106 deaths</a>.</p> <p>Researchers and public health officials determine how contagious a virus is by calculating a reproduction number, or R0. The R0 is the average number of other people that one infected person will infect, in a completely non-immune population.</p> <p>Different experts have <a href="https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/">estimated</a> the R0 of the Wuhan coronavirus is anywhere from 1.4 to over five, however the <a href="https://www.bmj.com/content/bmj/368/bmj.m308.full.pdf">World Health Organisation believes</a> the RO is between 1.4 and 2.5.</p> <p>If the R0 was higher than 2-3, we should have seen more cases globally by mid January, given Wuhan is a travel and trade hub of 11 million people.</p> <p><strong>How is it transmitted?</strong></p> <p>Of the person-to-person modes of transmission, we fear respiratory transmission the most, because infections spread most rapidly this way.</p> <p>Two kinds of respiratory transmission are through large droplets, which is thought to be short-range, and airborne transmission on much smaller particles over longer distances. Airborne transmission is the most difficult to control.</p> <p>SARS was considered to be transmitted by contact and over short distances by droplets but can also be transmitted through smaller aerosols over long distances. In Hong Kong, <a href="https://academic.oup.com/cid/article/58/5/683/365793">infection was transmitted</a> from one floor of a building to the next.</p> <p>Initially, most cases of the Wuhan coronavirus were assumed to be from an animal source, localised to the seafood market in Wuhan.</p> <p>We <a href="https://jglobalbiosecurity.com/articles/51/">now know</a> it can spread from person to person in some cases. The Chinese government announced it can be spread by touching and contact. We don’t know how much transmission is person to person, but we have some clues.</p> <p>Coronaviruses are respiratory viruses, so they can be found in the nose, throat and lungs.</p> <p>The amount of Wuhan coronavirus appears to be <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext">higher in the lungs</a> than in the nose or throat. If the virus in the lungs is expelled, it could possibly be spread via fine, airborne particles, which are inhaled into the lungs of the recipient.</p> <p><strong>How did the virus spread so rapidly?</strong></p> <p>The continuing surge of cases in China since January 18 – despite the lockdowns, extended holidays, travel bans and banning of the wildlife trade – could be explained by several factors, or a combination of:</p> <ol> <li> <p>increased travel for New Year, resulting in the spread of cases around China and globally. Travel is a major factor in the spread of infections</p> </li> <li> <p>asymptomatic transmissions through children and young people. Such transmissions would not be detected by contact tracing because health authorities can only identify contacts of people who are visibly ill</p> </li> <li> <p>increased detection, testing and reporting of cases. There has been increased capacity for this by doctors and nurses coming in from all over China to help with the response in Wuhan</p> </li> <li> <p>substantial person-to-person transmission</p> </li> <li> <p>continued environmental or animal exposure to a source of infection.</p> </li> </ol> <p>However, with an incubation period as short as <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200127-sitrep-7-2019--ncov.pdf?sfvrsn=98ef79f5_2">one to two days</a>, if the Wuhan coronavirus was highly contagious, we would expect to already have seen widespread transmission or outbreaks in other countries.</p> <p>Rather, the increase in transmission is likely due to a combination of the factors above, to different degrees. The situation is changing daily, and we need to analyse the transmission data as it becomes available.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/130686/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: http://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/c-raina-macintyre-101935">C Raina MacIntyre</a>, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, <a href="https://theconversation.com/institutions/unsw-1414">UNSW</a></em></p> <p><em>This article is republished from <a href="http://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-contagious-is-the-wuhan-coronavirus-and-can-you-spread-it-before-symptoms-start-130686">original article</a>.</em></p>

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