Health & Fitness

Molecular hydrogen (H₂ gas) has powerful antioxidant and anti-inflammatory effects,¹ making it potentially useful for COVID-19, as explained in this video by Tyler W. LeBaron, founder of the science-based nonprofit Molecular Hydrogen Institute.

In his video, LeBaron reviews the pathophysiology of COVID-19 and explains why H₂ is being clinically investigated by discussing the proposed mechanisms of how molecular hydrogen might ameliorate this particular disease.

In fact, several Chinese investigators are using H₂ therapy in COVID-19 patients,^2,3 and preliminary results^4,5 are encouraging enough that Dr. Zhong Nanshan, the epidemiologist who discovered the SARS virus (SARS-CoV-1) in 2003, is now recommending H₂ therapy for COVID-19.⁶

While more research is needed to confirm benefits and beneficial outcomes in COVID-19 cases, the latest COVID-19 treatment guide⁷ by the Chinese National Health Commission includes hydrogen inhalation.

LeBaron includes a video clip of Chinese patients given a hydrogen-oxygen inhaler mix, who say it eliminated chest pain and cough, and allowed for deeper breathing without discomfort. That said, LeBaron notes:

"There is still no clinically published evidence that H₂ will truly benefit COVID-19 and this information is solely for educational purposes. It does not constitute clinical evidence, and is not intended to replace the guidance from your health care practitioner."

Pathophysiology of COVID-19

As explained by LeBaron, the SARS-CoV-2 virus responsible for COVID-19 enters the lungs, where it attacks the type 2 pneumocytes,⁸ alveolar cells responsible for the secretion of surfactants that reduce the surface tension of fluids in your lungs and are thus important for elasticity.

The SARS-CoV-2 virus uses a spiked protein to anchor itself to the ACE-2 receptor⁹ of the cell. This is how it gains entry and releases its positive-sense single-strand RNA into the cell. By inserting its RNA, the virus essentially hijacks the cell, as it triggers viral replication to occur inside the cell.

In response, macrophages (white blood cells) are activated to combat the infection, and they in turn release a variety of cytokines, including interleukin-6 (Il-6), IL-1 and TNF-alpha, into your blood plasma. Once the cytokines enter your plasma, neutrophils are recruited, thus increasing vasodilation (expansion of your blood vessels) and capillary permeability. 

Inside the cell, reactive oxygen species (ROS) are also created in an effort to kill the infected cell and prevent viral replication. This is an essential part of your body's defense system. However, as the process progresses you end up with increasing amounts of ROS and inflammation. Worse, as the virus continues to attack your type 2 pneumocytes, your lungs cannot work correctly.

As the surface tension of the fluids in your lungs is reduced, your alveoli can no longer maintain the proper gas exchange, and your oxygen requirement goes up. Declining elasticity of the lungs also makes breathing more difficult. Add in high amounts of ROS, and the whole alveoli ends up dying. This is part of what's causing the cough.

As inflammation and vasodilation progresses, you can end up with low blood pressure, which is why you feel fatigued and weak. Lower blood pressure also causes low blood perfusion, which in turn means your cells will not get the oxygen and nutrients they need for optimal function. It also impairs metabolic waste removal. The low oxygen levels (hypoxia) result in feeling short of breath.

Unless successfully treated, this chain of events leads to cell death, multi-system organ failure (lungs, liver and kidneys), acute respiratory distress (ARD) and, ultimately, death.

Stopping the Destructive Cycle

To save the patient, something needs to be done to stop this destructive cascade of events. How do we inhibit viral replication and boost immune system function? As explained by LeBaron, most of the destruction occurs by ROS and systemic inflammation.

ROS are molecules that cause oxidative damage. However, they're not all bad all the time. Neutrophils that produce ROS also produce nitric oxide and superoxide, which are crucial. Superoxide helps kill the pathogen, but you also don't want too much of it, so it needs to be regulated.

Nitric oxide also needs to be regulated. While it can inhibit viral replication and helps boost your immune system, you don't want too much. As levels of superoxide and nitric oxide rise, they start forming peroxynitrites, which are extremely damaging, which in turn form hydroxyl radicals, the most cytotoxic ROS.

Normally, when superoxide has done its job, it's converted by superoxide dismutase into hydrogen peroxide, which in turn is converted into water and oxygen.

This process is regulated by a transcription factor called Nrf2/keap1. When this transcription factor is activated, it goes into the cell's nucleus, where it binds with the antioxidant response element (ARE), which triggers your body's natural antioxidants such as glutathione and catalase.

As noted by LeBaron, Nrf2 — which is involved in phase 2 detoxification — regulates more than 200 protective proteins and enzymes. The problem is that when ROS is overabundant and out of control, the Nrf2 system is depleted and can no longer regulate the inflammatory process.

Understanding Molecular Hydrogen

Molecular hydrogen or H₂ has the ability to activate the Nrf2/keap1 pathway, thereby replenishing your endogenous antioxidants. In so doing, H₂ helps regulate and maintain homeostasis in the whole system, preventing the infection from getting out of control and causing cell death.

Hydrogen can also downregulate NOX and NOS enzymes, thus lowering superoxide and nitric oxide production respectively. This is good, as when these two molecules are increased too much they instantly combine to create the pernicious peroxynitrite molecule. H₂ also supports your mitochondrial function. Importantly, H₂ selectively reduces peroxynitrites and hydroxyl radicals.

This gives H₂ a significant advantage over other antioxidants such as vitamin C, which act indiscriminately with superoxide and nitric oxide — both of which also have important and beneficial functions. H₂ does not interact with either superoxide or nitric oxide. The only thing H₂ can react with are the most dangerous ROS such as peroxynitrites and hydroxyl radicals.¹⁰

As a result, your superoxide and nitric oxide are left to perform beneficial functions while the H₂ eliminates the most dangerous byproducts of superoxide and nitric oxide, while simultaneously increasing your body's natural production of antioxidants and regulating the enzymes that produce superoxide and nitric oxide. To get a clearer picture in your mind of how H₂ steps in to break the destructive chain, see LeBaron's video.

H₂ also steps in to prevent a cytokine storm from occurring. A cytokine storm occurs when the upregulation of cytokines is greater than your body can handle. Cytokines are regulated by transcription factors, and ROS regulate these transcription factors. Inflammatory transcription factors, in turn, create more inflammation, which stimulate more ROS production.

This is a vicious cycle that results in increased cell death, which leads to multiorgan failure, which leads to death. H₂ has been shown to regulate these transcription factors in several animal and human studies, thus breaking the vicious cycle. This is what makes H₂ so anti-inflammatory. As summarized by LeBaron at the end of his video:

"Hydrogen gas, being a very simple, small molecule, can help to regulate the redox status of the cell by selectively reducing the very bad [ROS], help to regulate and improve the Nrf2/keap1 pathway to maintain our body's redox homeostasis.

It also has regulatory effects on inflammation, to lower chronic, harmful systemic inflammation by regulating everything. Just decreasing or inhibiting it [referring to ROS] is not want we want to do. We need all of these things.

This is in our immune system. We don't just want to get rid of it. Yes, it is what is killing us, but it is also very important to have, so that we can get better. So, that is the … rationale for [using hydrogen gas] for COVID-19."

Dosing and Availability

Although the specific clinical studies on COVID-19 are being conducted with H₂ inhalation, H₂ dissolved in water has been shown to be more effective than inhalation in other animal disease models.¹¹ Additionally, another article¹² suggests that the H₂-infused nitric oxide-producing beverage from H2Bev called HydroShot, should also be clinically investigated for its reported preliminary effects.

However, while there are various ways of getting H₂, the simplest and most practical delivery system is molecular hydrogen tablets that are dissolved in water. They are portable and can be taken anywhere, including travel and on airlines, and they consistently provide a high H₂ concentration. When using the tablets it's important to drink the water as soon as the tablets are dissolved and the water is still "white," as the H₂ dissipates quickly.

The molecular hydrogen tablets have the additional advantage of providing 80 mg of ionic elemental magnesium with each tablet. Magnesium can serve as a natural calcium channel blocker to help regulate high intracellular calcium levels that can wreak havoc in your body.

Also, the absolute quantity of H₂ is far less important than pulsing or creating an acute elevation of H₂ in your system over a short period. That acute elevation is what activates the Nrf2 pathway. When exposure is continuous, even if elevated, it has virtually no effect.

Clearly, we need more research to be better able to answer dosing questions, but in the interim, it seems customizing the dose to your personal circumstances would be most appropriate. So, if you're in normal, non-stressful circumstances at home, not really doing anything very stressful and not exercising much, maybe taking H₂ once a day is sufficient.

However, if you exercise a lot, you may want to take it two to three times a day to help reduce the oxidative stress from your exercise. Ditto if you're traveling and exposing yourself to free radical stress from ionizing radiation at 35,000 feet. In such a circumstance, it might be appropriate to take it every two hours while you're in the air.

Considering their safety, ease of use, and beneficial effects on immune function and health, molecular hydrogen tablets are a no-brainer solution in my view, and they could be quite helpful for many conditions, including COVID-19, which is why H₂ is being clinically investigated.

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Many of the headlines and predictions in the past few weeks have been dire. The fear and panic they spread can be paralyzing, making it difficult to adapt and develop a constructive plan for the future. Yet, in order to think clearly and identify the steps you can take to protect your health, it’s important that you control fear.

While it is helpful to stay up to date with changes, it isn’t necessary to get sucked in by the stylistic exaggerations of the media headlines. Instead, look for the facts and seek out your own answers.

Whether life returns to the way it was one year ago or not, the reality is that any return to “normal” is months away. When the shelter-in-place orders have ended, the repercussions to the food supply chain shutdowns may mean some industries won’t fully recover.

Dairy Farmers Incentivized to Close Their Farms

While milk is flying off the shelves in some stores, dairy farmers are being asked to dump hundreds of gallons of milk and sell their cows.¹ With restaurants and schools closed, the industry is sending all their supplies to grocery stores. However, when the shelter-in-place orders were first announced, grocery stores were limiting milk to one or two gallons per customer.

Those limits left dairy farmers with a glut of milk on the farm, while contending with plummeting prices. Richard Conrad, co-owner of Conrad Farms in New Holland, Ohio,² spoke with CNN. His farm supports 500 cattle and sales of milk account for two-thirds of their income. In the first few weeks it seemed the issue would be a short-term problem, but by the time of the interview, he realized he was wrong.

The Wisconsin Dairy Alliance said there is milk ready and waiting for processing, leaving food banks and pantries with a desperate need for dairy products.³ Several dairy groups have sent letters to the U.S. Department of Agriculture including a statement from the Professional Dairy Producers of Wisconsin:⁴

"America's freedom, strength and future hinges on its ability to feed its people. We must make sure that this crisis doesn't leave American weak by our inability to deliver food to our own people. There is no good reason for Americans to go hungry while our farms are the most capable and efficient in the world. We need immediate action."

The Ice Age Farmer published a letter on Twitter⁵ from the Ellsworth Cooperative Creamery in Wisconsin, in which the coop encouraged farmers to quit their dairy farms. In a stroke of irony, the letter was dated April 1, 2020.

Channel 7 news in Wisconsin ran a story on the letter April 3, 2020.⁶ Several people the reporter spoke with called the move “unprecedented.” Specifically, the letter encouraged dairy farmers who were unable to sell their milk, to sell their cows in the next 15 days.

In exchange, the cooperative promised the farmers a 100% equity payout in the coop from 2010 to 2019. The coop was trying to reduce production because grocers had begun limiting sales.

Produce Is Rotting in the Fields

The pandemic has also affected produce distribution. Strawberries, zucchini and tomatoes are just some of the fruits and vegetables left to rot in the field in Florida and California as farmers don’t have an outlet to sell their produce.⁷ Tony DiMare, tomato grower from south Florida, spoke to WTSP News 10, telling the reporter:⁸

“This is a catastrophe. We haven’t even started to calculate it. It’s going to be in the millions of dollars. Losses mount every day.”

Shay Myers is a large onion producer who recently posted a video describing losses on his farm in millions of pounds of onions.⁹ The onions were destined for restaurants and the food service industry but with the pandemic, demand has fallen. Myers aptly describes the disconnect in the ability get the produce to the end user during the pandemic, likening it to bridges being destroyed:¹⁰

"The way I've been describing it to people who aren't as accustomed to the normal supply chain is that imagine a freeway that is connecting a farm to the city. That freeway has a massive bridge that goes over a massive river and that bridge gets knocked out. If that bridge is knocked out you can't rebuild immediately.

Now, are there other routes to get there? Yeah, but it takes longer. And if it takes longer that means the normal product that's in that supply chain cannot make it. And that's what we're seeing today. Normal shipments in the United States, loads of onions, normal U.S. consumption is 350 loads a day.

We saw sub-200 shipments, 200 loads per day every single day last week. And the most recent number that I've seen is 127. That's one-third of the normal U.S. consumption of onions is being shipped.

That's the shift in the supply chain. That's why you're seeing milk being dumped, tomatoes being dumped, squash in Florida being dumped …”

Florida farmers had expected a huge bumper crop in spring, but for some, 80% or more of the crops are still in the field. It costs more to pick and pack the vegetables than what they’re being paid.¹¹ Some farmers have developed direct-to-consumer services and are experiencing a boost in sales, however. Evan Wiig, from the Community Alliance with Family Farmers, told The Guardian:¹²

“We’re using this as an opportunity to encourage collaboration and farmers working together to try to fill the gaps in this disruption. It’s been kind of a mad rush to figure out supply and demand and who needs what, who has what. This is usually something that you do carefully over the course of an entire year. And here we are trying to do it in a matter of a week in order to prevent the closure of the farms, and also a lot of food waste.”

Meat Packing Plants Shutting Down

Several meat processing plants around the U.S. have closed after multiple employees tested positive for COVID-19.¹³ While CNN¹⁴ tells their readers not to panic shop, Smithfield chose another tactic, warning the country’s meat supply is “perilously close” to¹⁵ being depleted.

Although the closings are devastating to some producers and could result in animals being housed in inhumane conditions, Steve Meyer, with commodity firm Kerns and Associates, believes consumers won’t notice the shutdowns. He said,¹⁶ "We have a lot of pork, we have a lot of chicken, we have a lot of beef in cold storage. We can draw on that should we have some shortages."

Some of the plants are diverting the work to other meat processing plants. Christine McCracken, analyst with multinational Rabobank, said the plant closures from staffing shortages may mean fewer options in the short-term, but not less meat on the grocery store shelves.

Seafood Industry’s Efforts to Keep Supply Chain Open

The fishing industry has also felt the pinch from dwindling demand as two-thirds of the seafood in the U.S. is consumed in restaurants.¹⁷ Fishing is a billion-dollar industry, paying the salary of 34,000 people. As the market for lobster, oysters and other shellfish has taken a downturn it’s left many without an income.

Much of the fish caught off the U.S. coastline is sent overseas where monkfish and dogfish are more popular. This has led to 90% of the seafood eaten in the U.S. being imported, while much of what is caught in the U.S. is exported. Red's Best is a wholesale company that purchases solely from small fishermen. It is led by founder and CEO Jared Auerbach.

Along with Marder Seafood, another wholesaler, they are buying, cutting and freezing fish to keep the fishermen in business and hedging their bets they'll have inventory to sell when the market opens in the coming months.

Auerbach is using another tactic to sell more fish to the U.S. market, partnering with a top chef from Boston, Jeremy Sewall, to shoot videos showing how to prepare fish at home. The objective has been to keep the supply chains open and functioning since restarting may be challenging if businesses must close their doors.

Supply Chain Interruptions Have Dangerous Consequences

The pandemic has exposed underlying problems within the fishing industry: Warming ocean temperatures have changed the fish population; overfishing has nearly extinguished some species;¹⁸ and U.S. supplies go to foreign markets while imports are sold to U.S. consumers.

Jason Delacruz, fisherman and wholesaler in Florida, spoke to Civil Eats about the current situation. One concern has to do with the snapper and grouper caught in the Gulf of Mexico. The fish are expensive but considered important to restaurants. Losing just 20% of that market could change the way they sell fish.

Meat is currently stable, but prices may rise if farmers go out of business.¹⁹ One of the largest meat processors, Tyson, put an exit plan in place nearly four years ago. In 2016, the company launched Tyson Ventures with $150 million. By 2018 they had partnered with four emerging food companies, owning less than 20% in each.

Speaking to the Chicago Tribune, Juston Whitmore, the head of the Tyson Ventures team, acknowledged there had been a shift in corporate goals after the new CEO took over. Tyson's new mission is to be a protein company, not just a meat company. He went on to say:²⁰

“I can’t express enough that we do see a world where there will be multiple types of protein products available. That could include (plant)-based protein next to pork, next to maybe even lab-grown protein and consumers will have a choice."

Beyond Meat is one of the food startups that is moving plant-based products (which resemble meat) into mainstream consumer purchasing outlets.²¹ Other backers for the plant burger that bleeds like meat are Bill Gates, General Mills venture capital organization and the Humane Society.

The company had its sights set on the fast food market when they named McDonald’s past CEO to their board of directors.²² By 2018, Beyond Meat burgers could be found at Epic Burger in Chicago, TGI Friday's and several grocers.

As if bleeding, plant-based, meat-like burgers isn’t enough, Reese Schroeder, the managing fund director for Tyson Ventures, said the company had a particular interest in automated food technology, which may include:²³

"3-D printing of food … It sounds kind of crazy, but there are companies out there trying to do that. There's a lot of cool tech and we're just scratching the surface."

Is It Time to Grow Your Own Food?

This short spoof published in 2009²⁴ was one way of preparing the public for the new “cool tech” in edible food, including GMO food and “green alternatives” with documented evidence it uses more resources than regenerative farming.²⁵

Glitches in the distribution of food products compounded by a food supply covered in pesticides and herbicides may be the impetus you need to plant your own garden at home. There are a wide range of personal and community benefits including increasing your activity, strengthening environmental health using organic principles and realizing significant stress reduction.

You don't need a big yard or farm to grow some of your own food. In fact, you can grow sprouts in an apartment near a window and potted vegetables on a balcony. Discover more in, "Is It Time to Start Growing Your Own Food?"

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A special report published today in the journal Radiology outlines prevention, diagnosis and treatment of complications stemming from blood clots in patients with COVID-19. The journal also published two research letters and a case study on this topic.

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Researchers have designed biocompatible ion-driven soft transistors that can perform real-time neurologically relevant computation and a mixed-conducting particulate composite that allows creation of electronic components out of a single material. These have promise for bioelectronic devices that are fast, sensitive, biocompatible, soft, and flexible, with long-term stability in physiological environments such as the human body. In particular, they could facilitate diagnosis and monitoring of neurological disease.

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New data suggests that Michigan nursing homes that responded to a survey were far better prepared for the COVID-19 pandemic than they were for the last one. The study includes responses from 130 nursing homes to a survey during the week that the state announced its first documented case of COVID-19.

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The COVID-19 pandemic has been described as “the war of our generation.” Millions of families are bravely waging war on COVID-19 by rising to the many challenges of social distancing, including upended school and work routines, financial insecurity, and inability to see loved ones, all compounded by the uncertainty of how long this will last. These challenges are likely magnified for those with autism spectrum disorder (ASD). Features of ASD, including impaired social and communication skills, repetitive behaviors, and insistence on sameness, can make it very difficult to understand social distancing, express distress, and adapt to new routines.

What has the impact of the COVID-19 pandemic been on teenagers with ASD and their families?

Social distancing has created many new challenges for families caring for teenagers with ASD in the home. Many teenagers with ASD receive support services including special education, behavioral therapy, occupational therapy, speech services, and individual aides through school. Delivering these services virtually is a major challenge, particularly since many teenagers with ASD already have social and communication difficulties, limiting the utility of video chat. Parents are therefore finding themselves simultaneously expected to play the role of parent, special education teacher, and individual aide, all the while providing care for other children and juggling work-from-home responsibilities. Aggressive and self-injurious behaviors may also increase during this time of fear and uncertainty.

What about young adults who live in group homes?

Group home residents have been impacted by social distancing in several unique ways. First, many group homes across the United States have restricted visitors to legal guardians. For many, this means that they are not permitted in-person visits with parents. Second, group home residents are now no longer permitted to engage in their normal routines at day programs and work sites. Because of these restrictions, group home residents are now generally confined to their group homes, and social interactions are limited to ad hoc activities with other residents and staff members, often within the group home. Third, the disappointment of missing highly anticipated events such as outings and family holidays can be amplified for a person with a limited understanding of the pandemic, particularly for those with intellectual disability. Many individuals with ASD may even view these restrictions as punitive, increasing the risk of anxiety, depression, or behavioral outbursts.

Strategies to support teenagers and young adults with ASD during COVID-19

Educate teenagers about COVID-19. Since confusion can fuel fear and anxiety, it is important to educate teenagers and young adults with ASD about COVID-19 and social distancing. Exposure to COVID-19 through the media can be overwhelming and misinterpreted. The language used when discussing COVID-19 should be clear, direct, and adapted to the person’s cognitive ability. It may be helpful to use a visual aid. Many people also have misperceptions and catastrophic fears about COVID-19, so it can be helpful to ask directly: “What do you know about COVID-19?” and “What worries you most about COVID-19?” Allow the teenager or young adult with ASD to guide how much or how little he/she would like to know and when he/she would like to talk about it.

Keep the routines that you can keep. Routines are very important to people with ASD. While many of our routines have dramatically changed, there are also many routines and rituals that we can help keep the same, such as mealtimes, bedtime, and other schedules (for example, “I always call Grandma on Sundays.”).

Create new routines. It can be helpful to replace the activities that are no longer possible with new routines to help create a new normal. When possible, these routines should incorporate social connectedness, fun, and physical exercise (like family dance parties after dinner).

Practice old coping skills and learn new ones. This is the time to recall and remind the teenager or young adult of coping skills that helped him/her manage challenging situations in the past. These may include listening to familiar music, visual aids to bolster communication, engaging in hobbies, or talking with friends and family.

Increase communication. It is natural for parents and children to worry about one another, particularly when in-person contact is limited, as it is for those who live in group homes. Open and frequent communication between group home staff and family members about policies and practices to optimize infection control, as well as how residents are doing, can help alleviate these worries.

Plan something to look forward to. Since many spring events including vacations and family holidays have been cancelled, it can be helpful for families to plan delayed events or celebrations. Planning these events not only creates something positive for a family to look forward to, but they can also serve as a powerful reminder that this too shall pass.

Seek mental health services. If your teenager or young adult is having difficulty coping or is exhibiting increased aggression or self-injury, it is important to seek mental health services. Many clinics are continuing to provide care through telehealth, including talk therapy and medication management.

Teenagers and young adults with ASD can learn valuable life lessons

If teenagers with ASD are well-supported and socially connected during these difficult times, this period of social distancing may serve as a catalyst for personal development rather than a time of regression and loss of skills. If we engage with teenagers with understanding and good role modeling, we can help young people with ASD to tolerate uncertainty, accept what is beyond their control, and build their resilience and resources — things they can control.

Resources

Guide to Mental Health Resources for COVID-19, Massachusetts General Hospital Department of Psychiatry.

COVID-19 information, Center for Autism Research and Treatment, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles.

Coronavirus/COVID-19 Resource Library, American Academy of Child & Adolescent Psychology.

The post Strategies to support teens and young adults with autism spectrum disorder during COVID-19 appeared first on Harvard Health Blog.

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Due to injury or necessary surgery (splenectomy), some people are lacking a spleen, the organ that filters the bloodstream and helps the body fight infection. You do not need your spleen to live a normal, healthy life. However, since the spleen performs some important tasks, people who do not have one are urged to take certain precautions.

What is a spleen?

The spleen is a fist-sized organ that sits under your rib cage on the left side of your abdomen. Unlike the stomach, liver, or kidneys, it is not directly connected to the other organs in your abdomen. Instead, the spleen is connected to your blood vessels, with an artery that brings blood to it and a vein which takes the blood away.

The spleen is composed of two types of tissues: the red pulp, which filters the blood, and the white pulp, which contains white blood cells that regulate inflammation and the body’s response to infection. Both types of tissue play roles in fighting pathogens (bacteria, viruses, fungi, or parasites) that cause infections.

What does red pulp normally do?

The red pulp removes red blood cells — which carry oxygen — when they are old, damaged, or infected. It harvests the iron from the old red blood cells for recycling into new blood cells. Usually new red blood cells are created by the bone marrow, but when blood counts are low or the bone marrow is not working well, the spleen can also make new red blood cells.

The loss of the spleen’s ability to filter out infected red blood cells increases risks associated with two parasitic infections, malaria and Babesia. Malaria is spread by mosquito bites in many parts of Africa, Asia, and South and Central America. Babesia is spread by tick bites in the Northeastern and upper Midwestern part of the USA (a different species of Babesia is found throughout Europe). People without a spleen should take extra precautions to avoid these infections if they live in or visit a region where malaria or Babesia are common.

An area in the red pulp called the marginal zone contains special white blood cells known as splenic macrophages that filter pathogens out of the blood. This is a particularly important defense against a type of bacteria coated in a capsule that resists many of the body’s other defenses. These bacteria can be tagged by antibodies produced by the white pulp of the spleen, then killed by the splenic macrophages.

Someone without a spleen is at increased risk of severe, or even deadly, infections from these encapsulated bacteria. Fortunately, vaccines significantly decrease the risk of these infections, and are available against the most common types (Streptococcus pneumoniae, Haemophilus influenza, and Neisseria meningitidis). Additionally, it is usually recommended that people without a spleen have antibiotics that they carry with them (often referred to as “pill in pocket”) and can take at the first sign of an infection, such as fevers or chills. For children without a spleen, their doctors may even recommend they be on antibiotics all the time. Talk to your doctor about this.

What does white pulp normally do?

The white pulp is composed of lymphoid tissue, which contains white blood cells, the body’s primary means of fighting pathogens and regulating inflammation. White blood cells act as the body’s police force — patrolling the bloodstream to find infections or damage to the body, and working together to combat it. There are many types of white blood cells that function in different and often complex ways. Some fight infections directly, by releasing substances that are toxic to pathogens or by “swallowing” them (called phagocytosis). Some fight infections indirectly, by assisting the direct fighters or by producing antibodies that mark pathogens for destruction by other white blood cells.

Fortunately for people who do not have a spleen, the body has other lymphoid tissues containing white blood cells, such as lymph nodes. For many types of infections, the remaining lymphoid tissues are able to mount an adequate response. However, with the loss of the lymphoid tissue in the spleen, the immune system fights infections with a bit of a handicap. That’s why the Centers for Disease Control and Prevention recommend that people without a spleen get vaccinated against preventable diseases, including influenza (flu). Discuss vaccinations with your physician.

COVID-19: Does not having a spleen affect ability to fight this illness?

At this point, we do not know for sure how lacking a spleen might affect a person’s ability to fight COVID-19. For most viruses, not having a spleen does not seem to be a major risk factor for illness.

So far this seems to be true for COVID-19 as well. New studies are being published constantly, but lack of a spleen has not been identified as a risk factor for acquiring COVID-19 or having worse outcomes. This is likely because the other lymphoid tissues in the body are able to produce an adequate response. However, it is likely that a person’s ability to fight any infection is at least a little diminished compared to what it would be if they did have a spleen. So with an infection like COVID-19 that can be severe and deadly even in healthy individuals, anyone without a spleen should be extra vigilant in following CDC recommendations to protect themselves and others.

The bottom line

If you do not have a spleen, ask your doctor what steps to take to prevent infection or illness. This might include precautions about mosquito bites and tick bites, vaccinations, and whether you should carry antibiotics (“pill in pocket”). If you have a fever of 100.4° F or more, you should take your pill in pocket if you have it, and seek urgent medical attention.

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