Dr. David Watkins On The Peter Attia Drive Podcast #115
2020: The Year Everybody Became a Virology Expert
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Note: This podcast was posted on June 15, 2020.
“Up until 2 months ago, I did not know that the antibodies [I] measure in a person’s serum, whether it be to coronavirus…or those that I’ve looked at my entire medical career when I check[ed] a patient’s antibody levels...that I was not necessarily being assured of immunity because I had no incite into whether those were neutralizing or not.” - Peter Attia on the widely unrecognized importance of neutralizing antibodies.
Changing Tides
Let me take you back to 2019, when kids flooded classrooms, where working remotely was a fairytale, where handshakes and hugs were courtesies, and when there was only a fraction of the population espousing opinions on viruses and pandemics. Now flash forward a few months to find yourself amidst a global shutdown, where schooling from home is the status quo, where your work is only a few clicks away from your bedroom, where your in-person social life is nearly non-existent, and where you are wondering what the hell everybody is talking about with coronaviruses, mRNA vaccines, and R0 values. Of course, we cannot forget to include the constant social media bombardment, filled with millions of people who became virology and public health experts overnight, nor can we leave out the biased news stations that never fail to twist and misinterpret scientific data to endorse their political party of choice. Debates on masks, vaccines, and lockdowns crowd your feed, invade your family dinners, and pressure you to pick a side. So what’s your move? Or more importantly, what’s backing that move? We’ve already come to grips with the fact that you are fighting way out of your weight class and don’t know what the fuck a pangolin is, or how DNA works, or why some people get sick and other people don’t, so what are you left with to guide your decisions? Now, you might be catching on to my point here: if you don’t have a baseline understanding of the science and mechanics that drive topics as complex as those underlying the COVID-19 pandemic, then you are left stranded and vulnerable to misinformation, virtue signaling, and political corruption.
Changing Minds?
When I first listened to Dr. Peter Attia’s discussion with Dr. David Watkins, professor of pathology at George Washington University, it immediately struck me as an opportunity for laypeople to start to step away from the noisy and divisive world described above; particularly, this podcast provides the opportunity to understand a topic at the heart of the pandemic: immunology. Through breaking down the immune system’s different cells and processes, Attia and Watkins paint a picture of what occurs when your body encounters a virus or a vaccine, providing incites into mechanisms that directly apply to hot topics related to COVID-19. Having spent his career tackling complex virology challenges, such as Yellow Fever, HIV, and Zika, Watkins provides a unique perspective into the worlds of microbiology and vaccinology not only in terms of SARS-CoV-2 but as a whole.
“This is the most dramatic example of evolution that I have certainly ever seen.” Dr. Watkins on his work with HIV.
I understand that much of the medical lingo they use may be confusing, so I encourage you to look into this episode’s show notes for clarity; additionally, I will provide you with some analogies below to help you understand the big players and functions underlying the discussion.
“I used to think that the most important cell in the body was the cytotoxic T-cell. And, worse than that, I used to think that the heart had one function, and that is to pump T-cells around.” - Dr. David Watkins sarcastically describing his early fascination with cytotoxic T-cells.
Changing Lives?
My goal with this post is not to suede you one way or another on masks, lockdowns, or vaccines; rather, it is to start you on a path to understanding the science behind the pandemic, so that you can use it to make your own educated decisions. In addition, it is to employ you to take the same approach before drawing conclusions on any other topic that you don’t understand.
“Guys try everything that you can, we need everybody’s approaches.” - Dr. Watkins’ message to scientists and physicians working on solutions to the COVID-19 pandemic.
Defending Your City
Here are some analogies to help you understand the basics of the immune system that Dr. Attia and Dr. Watkins cover in this episode.
Imagine you are living in a big city (your body), in which a multi-tiered security system (your immune system) filters incoming and outgoing traffic in an attempt to keep the city safe. Most of the time, this system works incredibly well, bringing traitorous citizens (like cancerous cells) to a halt, as well as defeating and destroying violent invaders (bacteria, fungi, viruses, etc.); however, sometimes these criminals make it through the cracks and cause a world of havoc.
For example, imagine a group of radical individuals (a bunch of viral particles) make it through the city gates (your nose, mouth, eyes, etc.) and start damaging citizens and their property (your body’s cells and systems), lighting houses on fire and assaulting innocent victims. Your city’s security system (immune system) will send out its first response force (the innate branch of the immune system), consisting of firefighters, EMT’s, and police officers (macrophages, neutrophils, natural killer cells, etc.) to attack the problem with direct, blunt force trauma. In this process, they might break a few store windows or damage some vehicles (analogous to the damage that inflammation can cause to your body) in an attempt to combat the invaders and the damage they are causing.
Amidst this commotion, behind the scenes and hard at work is the security system’s second tier: the FBI detectives (the adaptive branch of the immune system). They received word of the attacks through their messenger alarm system (CD4 helper T-cells), which brought them specific data to use to uncover the identity of these assailants. In particular, these messengers tell them that the group of criminals can be easily identified by their purple hats (analogous to a virus antigen). With this intel, the FBI’s mercenaries (CD8 cytotoxic T-cells) can search the city’s buildings and homes (your body’s cells) for the enemies wearing purple hats and wipe them out; furthermore, they are guided by the hats that citizens hang on their doorsteps (MHC signaling molecules on the surface of all of your cells), of which the yellow ones represent areas without criminals and the purple ones represent areas with criminals. In addition to these assassins, the FBI contains surveillance analysts (B-cells) that are reviewing the intel from the messenger alarm system and cameras around the city to create a very close depiction of the criminals. With this depiction, they can quickly identify them throughout the city and send a response team (antibodies) built specifically to neutralize this group of criminals.
Through the fire and the flames, your security system manages to defeat the group of criminals, expunging them from the city and saving its citizens; however, they do not forget this invasion and assign long-term security analysts (memory B-cells) to survey the city for more of these criminals with purple hats, so that the system can respond rapidly and effectively if they strike again.
In case you are completely lost, allow me to break this down in literal terms. When a foreign organism, like a virus or bacteria, invades your body, your immune system’s first response is to send its innate branch (analogous to first responders) to search and destroy said foreign organisms. This process consists of cytokines inducing inflammation and macrophages (I think of them as little pac-men) engulfing and breaking down foreign viral and bacterial particles. While this occurs, the adaptive branch of the immune system prepares a response that they will unleash roughly 4-7 days after the foreign organism invaded. CD4 helper T-cells (messengers in the alarm system) initiate this response by activating CD8 cytotoxic T-cells (mercenaries) and B-cells (surveillance analysts), presenting them with antigens (pieces of the virus or bacteria) with which they can develop a response specific to the virus or bacteria. Once this process is complete, cytotoxic T-cels search for cells infected by the virus or bacteria, which they discern based on the MHC molecules on the surface of all of the cells in the body (analogous to the hats on the citizens’ doorsteps). Healthy cells will present MHC molecules that do not activate the cytotoxic T-cells; whereas, infected cells will display one of the virus or bacteria’s antigens in their MHC molecules, signaling for the cytotoxic T-cells to destroy that cell. The B-cells will replicate and multiply, selectively breeding cells that produce antibodies capable of neutralizing the virus or bacteria (analogous to the special teams that neutralized the criminals) — preventing it from entering cells or functioning properly. After the virus or bacteria is defeated, some of your B-cells stick around as memory B-cells and continue to emit these antibodies, so your immune system can launch a rapid and effective response if it encounters this virus or bacteria again.
Now, it is important to note that I am far from an expert in immunology and that this is an extremely simplified explanation of an immune response that leaves out many of the intricacies and nuances that go into the immune system’s functions. That said, if you understand these basic concepts, along with the concepts in the podcast with Dr. Attia and Dr. Watkins, then you will know more than most regarding immunology, giving you some starting tools for understanding and interpreting headlines you see in the news, articles you read online, and debates regarding the pandemic.