Robust and durable

Infectious disease research and daily practice have taught us that antibodies are only part of the memory immune response and that adaptive cellular immunity in the form of memory cells plays a fundamental role. 90 years after the 1918 influenza pandemic, immunity to influenza was discovered Many studies have shown that immunity can be robust and long-lasting, even with SARS-CoV-2.

In recovering patients, SARSCoV-2 antibodies have been shown to persist for up to 7 months, although at lower levels compared to the responses detectable in the first months These antibodies have been shown to block the implantation of different genetically variant viruses. In addition, the authors noted that CD4⁺ and CD8⁺ cells produced γ-interferon, with no downward trend so far during the observation period. Another study found that receptor-binding structural domain (RBD)-specific antibodies with potent antiviral activity were present in all individuals tested, despite limited levels of neutralizing antibodies.

Other findings suggest that t-cell immunity persists. Rhesus monkeys have been found to be immune to sequential viral attacks, with multifunctional SARS-COV-2 specific T cells, characterized by a stem-like memory phenotype, present in the recovery phase. These cells are present in exposed family members, even if they are seronegative, and in patients with a history of asymptomatic and mild infection.

The immune system of T and B cells appears to play a complete role in the response to the virus. A recent paper assessed the persistence of SARS-COV-2 antibodies together with specific memory cells (specifically spike-specific memory B cells, SARS-COV-2-specific CD4⁺ T cells, and SARS-COV-2-specific CD8⁺ T cells). This made it possible to assess the relationship between different aspects of immune memory Most patients showed complete responses to each immune memory zone 1-2 months after infection, while at 5 months 40% of patients remained positive in 3 of the 5 zones, with a fan-shaped dispersion of responses over time. Notably, all immunomarkers were negative. As shown in Figure 2, in each case, the memory for SARS CoV-2 was traceable in the early (1-2 months), middle (3-4 months), or late (5+ months) stages.

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Similar data were repeated in another group of patients 6-8 months after infection In the present case, although serum levels of anti-SARS - COV -2 IgG antibodies decreased, virus-specific T and/or memory B cell responses increased over time and remained constant throughout the study period. Thus, in the period following the SARS-COV-2 infection, organisms tend to track its passage in the compartment most precisely used to reorganize defenses in the event of a new attack. These data point in the direction of only one occurrence of SARS-COV-2 infection and increase the hope that one vaccination in a lifetime will be sufficient.

Our comment

Following the path of deductive reasoning is part of our daily clinical practice. The classic image of the triad applies to SARS-COV-2. We know that respiratory viruses have permanent immunity: this simple assumption forms the basis for the use of live attenuated virus vaccines that have defeated the most dangerous of these viruses, such as smallpox and measles Therefore, it is logical to believe from the outset that this virus may determine permanent immunity Indeed, we know very little about the SARS CoV-2 immune response kinetics is poorly understood; but which viral disease does not end in long-term immunity after viral clearance due to some stabilizing factor? Even if the exact duration of memory has not been determined, it is unlikely that it lasts only a few weeks. We fully agree with Nicole Baumgarth that "the skepticism necessarily expressed in the introduction of a scientific paper is intended to raise scientific questions and must not be mistaken for a statement of lack of knowledge".

In those analytical reasonings that are asked to investigate the immunological aspects of SARS-CoV-2, all aspects of immunity against this particular virus must be evaluated. In some articles examining primary antigenic antibodies, cellular immunity, and natural immunity, the premise sounds like this, "We know nothing about this particular aspect of the SARS-CoV2 immune response." This praise for the lack of evidence should not be interpreted as a lack of evidence for permanent immunity. Each of these studies provides an in-depth contribution to certain immunological aspects, but must not lead us to lose sight of the complexity of the interactions between different immune lineages with the aim of achieving permanent immunity Therefore, we are not surprised by the results of recent studies on the persistence of antiviral immunity They confirm what we have always known, but often left unsaid.

Cistanche extract

Practical consequences

These observations have important practical implications.

First, immunization against the new coronavirus should not be given preferentially to those already infected. Although previous infection is not inconsistent with augmentation of the natural immune response by vaccines, immunization of already immunized subjects is not usually required in viral infections. Long-term desired immunizations are expected to induce disease-attenuating immunity for all uninfected individuals, but because they are primarily parenteral, they are expected to induce IgG but not secrete IgA47. Therefore, it is doubtful that they produce bactericidal immunity48, although it is logical that antibodies formed in immunized individuals inhibit cell entry and expansion of the virus. allowing viral load and associated transmission risk to remain allowed to be ignored by those who do. We expect that natural immunity will persist over time, whereas the duration of vaccine immunity is likely to be limited.

Secondly, proper identification procedures for immunization targets can exempt them from the restrictive measures imposed by the authorities in the context of the epidemic. We recognize that the concession of an "immunization passport" is complex, involving not only scientific but also ethical, organizational, and economic aspects; however, as the proportion of the population already infected with AIDS increases, it is inevitable that these individuals will somehow be recognized and fully emancipated. The embargo severely restricts human activity50,51 and we believe that it is morally unacceptable to restrict the mobility of people who pose no risk to others. We believe that, with all the necessary technical equipment, it is important to identify individuals who can move freely, stay in hotels, and carry out work activities.

Standardized Cistanche

Improving immunity means improving the body's ability to resist invasion by various viruses and to prevent and treat various diseases. It is easy to say but difficult to do. Due to the differences in objective factors such as gender, age, lifestyle habits, and nutritional status of the body, the relative methods and approaches to improve immunity are also different, and long-term persistence is needed to achieve the purpose of improving the body's immunity.

Cistanches are consumed by the elderly as a warm tonic to strengthen their immune system! Cistanches are usually grown in the desert and are also known as geophytes. It is an excitatory pituitary that has a hormonal effect and is a valuable herb that regulates the immune system. The polysaccharide content in Cistanche is relatively high, and it can increase the number of cells and prolong the life span. When taken by the human body, it can break down the lymphocytes, thereby increasing lymphatic activity to improve the body's immunity.

Cistanche supplements

REFERENCES

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Alessandro Fiocchi ^a; Erika Jensen-Jarolim ^b，c

a. Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.

b. The Interuniversity Messerli Research Institute of the University of Veterinary Medicine Vienna, Medical University Vienna, and University Vienna, Vienna, Austria.

c. Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectivology and Immunology, Medical University of Vienna, Vienna, Austria.