Are Immune Boosters the Panacea for COVID-19 Management?

Key takeaways

• Immune boosters and nutritional supplements do not cure or prevent the disease.
• At this stage of the COVID-19 pandemic, there is no known conventional cure. Claims of alternative medicines such as immune boosters and nutritional supplements as treatment options for COVID-19 are unverified.
• The only sure way to prevent infection is to avoid exposure to the virus by observing physical distancing, practicing frequent hand hygiene, and avoiding touching the face.

With no known cure for COVID-19, there has been a surge in the demand for immune boosters, ostensibly to “assist” the immune system in warding off the pathogen that causes the disease. That is not difficult to understand. Of course, if anyone is going to catch the virus, it would be best if their immune system is in the best possible shape. But how do we really boost our immune system? Many of my patients have enquired about taking food supplements, probiotics, and herbal immune boosters. The response to this query is not as straightforward as it may seem. Many of them erroneously believe that an “enhanced” immune system will protect them from contracting the virus. To be certain, the only sure way to prevent infection is to avoid exposure to the virus by observing physical distancing, practicing frequent hand hygiene, and avoiding touching the face. However, to adequately address this issue, it may be necessary to briefly discuss how our immune system works.

The Immune system

The immune system is a complex network of cells, tissues, and organs that work together to defend the body against attacks by “foreign” invaders, which are primarily infection-causing organisms such as bacteria, viruses, fungi, and parasites. Generally, and for simplicity, the immune system works along three lines of defense. Physical and chemical defenses are the most rudimentary form of innate immunity and the first line of defense against invading pathogens. The skin, mucus membranes, tears , and vaginal opening work to keep invaders out of the body.

If an infectious pathogen invades and is able to infiltrate a host’s physical defense system, innate immunity is used to halt progression of the infection. Innate immunity is present from birth and utilizes a preexisting but limited repertoire of receptors to recognize and destroy pathogens. Innate immune cells are a group of white blood cells. When these cells are stimulated by foreign pathogens, some of them secrete inflammatory mediators. Some of these cells also act as phagocytes, which allows them to recognize, internalize, and destroy invading pathogens.

The third line of defense is mounted against specific pathogens that cause diseases. Specialized cells produce specific antibodies against the pathogen, and the cells that have become infected are killed.

Can we truly boost the immune system?

In the strictest sense of the word, the only evidence-based approach to truly “boosting” the immune system is immunization, either through vaccination or by passively providing immunoglobulins (antibodies) to patients against specific antigens. Not only is “boosting” the immune system in general impractical, it may not necessarily be a good idea. This is because the immune system is tightly regulated to work within a limit, and an overactive immune system presents with many challenges.

Usually, the stronger the immune response mounted against an invader, the higher the chance of fighting off the infection. This partly explains why children and younger people are relatively less vulnerable to the coronavirus. Conversely, the increased risk of severe COVID-19 and death in older people is partly explicable by immunosenescence– the gradual deterioration of the immune system as a result of aging.

When the immune system is done fighting off an invader, it is programmed to shut itself off. In some few cases of people battling with serious infections, the immune system may still rage on even when the pathogen is no more a threat. This overactive immune system can harm the body’s own organs and even cause death. In this case, it is the body’s response that harms the patient and not the pathogen itself.

Are immune supplements important then? Our body requires food nutrients in optimum quantities to support our daily functions, including those that help the immune system to work optimally to protect us against many infectious diseases. Moreover, malnutrition and micronutrient deficiencies are strongly associated with impaired immunity. It is well recognized that nutrition is a crucial factor in modulating immune homeostasis.

Considering the current COVID-19 pandemic for which there is no effective preventive and curative medicine available, a healthy immune system is the most important weapon against the viral infection. However, it is worth noting that every system of the body functions better when it is supported by healthy lifestyle choices, which include eating varied and balanced diets rich in fruits and vegetables, doing regular aerobic exercises, and having adequate sleep.

It must be emphasized that no “immune boosting” supplements can replace a varied and balanced diet. However, in the absence of proper nutrition, especially in these times when movement is restricted and the food supply chain may be disrupted, supplementation with important vitamins and trace elements may be beneficial. At the two epicenters of the COVID-19 pandemic in Ghana, which are Accra and Kumasi, protein-energy malnutrition is largely uncommon. However, subclinical deficiencies of at least one micronutrient may be prevalent in the population, when you consider that the indigenous diet is largely carbohydrate-based.

However, supplementation should not be viewed as the magical wand that will suddenly switch the immune system into full gear. A false sense of protection can be dangerous. It is still important that we observe the preventive protocols such as hand washing, social distancing, and the use of a face mask where necessary.

There are several vitamins and trace elements which are essential for normal functioning of the immune system; important among them are Zinc, Selenium, Copper, Magnesium, and Vitamins A, D, E, and C.

For a viral pandemic like COVID-19, for which there is no universally accepted preventive or curative pharmacotherapy, and whose exact time of ending looks gloomy, nutritional strategies for supporting immunity is something to be explored. Selective micronutrient supplementations may be beneficial, especially for vulnerable populations such as the elderly.