Employee resilience is more than just mindset
How has your team's resilience been affected by Covid-19?
One of the biggest challenges that companies face as they look to the future is understanding how to protect the resilience of their workforce.
Resilience is the foundation to sustainable high performance, regardless of a person’s seniority and industry.
With resilience, we can deal with uncertainty, face challenges, support others, lead ourselves and reach key goals.
Without resilience, everything is compromised. Our health is depleted. Our energy is compromised. Our clarity of mind and executive function is less than ideal.
So how do you talk about resilience with your employees? Are you aware of what resilience means, from a scientific rather than behavioural perspective?
Watch the video below, and get in touch with questions. At 360, we can not only educate your teams on resilience in high performance, we can measure it accurately too using our app.
WATCH US TALK ABOUT RESILIENCE
There has never been a more important time to measure, understand and support the resilience of employees.
With a new “hybrid” workforce, the potential for post-pandemic fatigue, and the effect of cumulative stress from the past 18 months, now is the time to understand the needs of your team to support culture and productivity.
We offer a guarantee of impactful data in 30 days or your money-back. Get in touch today.
Understand the resilience of your teams in 30 days, of your money-back.
360 Wins Digital Health Award
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We are over the moon to learn that 360 has won Gold at the London Design Awards for Digital Health.
We are so happy for everyone involved; our digital team at Tigerspike, our clients who have given us amazing feedback since we first launched the app in 2016, and of course those in 360 who have helped shape everything from concept to completion.
You can learn more about the awards here. From ground-breaking apps accelerating medical research to apps helping consumers make healthier choices, Driven by Design looks for apps that are making health information and medical services more accessible to all.
We are incredibly proud to have won the Digital Health category and truly excited about the future.
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Immune Responses and the Clinical Spectrum of COVID-19
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Introduction
When the pandemic hit in the early part of 2020, the world was dealing with an unknown virus. As of today, 56,236 peer-reviewed research papers have been published on COVID-19. We know so much more.
In this piece, we briefly review normal immune responses, abnormal immune responses, and the opportunity lifestyle medicine offers all of us to improve immune resilience. Why is this important now?
Top-down epidemiolgiocal modelling of the virus has its place for public policy, as long as it uses approriate assumptions. Bottom-up understanding of how our biology responds to the virus is vital from a personal wellbeing perspective. Education is king.
Coronavirus disease 2019 (COVID-19) is a disease caused by SARS-CoV-2. What follows is an overview of how the body becomes infected, our immune response to SARS-CoV-2 in both healthy and abnormal situations, and the lifestyle implications this brings.
SARS-CoV-2
SARS-CoV-2 belongs to the family of Coronaviruses. Coronavirus includes several species capable of infecting various animals, and some of which also affect humans.
SARS-CoV and MERS-CoV had a low level of transmission, but a high level of lethality. SARS-CoV-2 is easier to spread compared to former coronaviruses, but it is not as lethal. A September 2020 systematic review estimated worldwide infection death rate of 0.68%. However, this number will change over time as data collection improves. Death rate appears to be primarily dependent on age and underlying health status.
Research suggests that nearly 80% of all infections remain undocumented because patients are either asymptomatic or present with very mild symptoms.
SARS-CoV-2 incubates for an average of 5.8 days. Incubation represents the time in days from the point of COVID-19 exposure to the onset of symptoms.
Upon entry into cells, viral RNA from SARS-CoV-2 gets released into the cytosol, and the virus exploits the cell machinery to replicate. The rapid viral replication causes cell damage, the release of pro-inflammatory cytokines, and the recruitment of inflammatory cells.
How Novel Is This Coronavirus?
Early in the pandemic, public health officials were unsure how the immune system would respond to SARS-CoV-2, and if a level of immunity was even possible after infection. This concern may have formed one of the assumptions behind initial lockdown strategies. We now understand a lot more about the virus, and the body’s response to infection. Two takeaways are essential here:
First, research shows that the immune system does identify SARS-CoV-2.
Second, it appears we also have a level of pre-existing immunity. At least six studies have reported T cell reactivity against SARS-CoV-2 with no known exposure to the virus.
A paper published in the prestigious journal Nature found SARS-CoV-2-reactive T cells in at least 35% of unexposed healthy individuals. The authors of this study concluded by saying:
Our study reveals pre-existing cellular SARS-CoV-2-cross-reactivity in a substantial proportion of SARS-CoV-2 seronegative healthy donors. This finding might have significant epidemiological implications regarding herd immunity thresholds and projections for the COVID-19 pandemic.
SARS-CoV-2 may be novel, but our immune system does an excellent job of recognising it.
A Healthy Immune Response to SARS-CoV-2
First Line of Defence: Innate Immunity
The first line of defence against SARS-CoV-2 is the innate immune system. Mucosal immunity refers to the production of mucus, designed to trap viral particles, be swallowed and eliminated via the gastrointestinal tract. If this barrier gets breached, there is another line of defence involving pattern recognition receptors (PRRs).
PRRs are like reconnaissance soldiers. They look for “stranger and danger” recognising different molecular structures characteristic to SARS-CoV-2. PRRs identify known viruses, bacteria and other types of pathogens that humans have had over many millennia.
PRRs recognise the SARS-CoV-2 virus and begin the inflammatory response via signalling pathways, such as NF-kB. The result is the activation of various cytokines, such as IL-6, TNF-a and IL-1b.
You can think of these cytokines as the troops. They attack and kill the virus. They are also crucial in communicating with the adaptive immune system so that we develop appropriate antibodies, and with it, the potential prevention of reinfection to SARS-CoV-2 in the future.
Second Line of Defence: Adaptive Immunity
The adaptive immune system helps to build memory and future immunity against the virus. T cells are hugely crucial in long-term immune resilience to SARS-CoV-2:
– CD4+ T cells stimulate B cells to produce SARS-CoV-2-specific antibodies
– CD8+ T cells target virus-infected cells and kill them with cytotoxic molecules, such as granzyme A
80% of the infiltrating cells in COVID-19 are CD8+ T cells.
It is worth noting that current estimations of community immunity cited by many in the medical community refer only to B cell SARS-CoV-2-specific antibodies. However, this approach ignores the role of sIgA and T cells in generating a level of immunity and protection against the virus.
For example, a study into the original SARs-CoV virus found that six years after the virus, there were no SARs-CoV-specific B cells detectible in 91% of patients. However, there were SARs-CoV-specific memory T cells present in 61% of the SARS survivors studied.
In the image below you can see the difference between normal and abnormal responses to COVID-19:
An Unhealthy Immune Response to SARS-CoV-2
Given the capacity of the immune system to target, kill, clear and remember SARS-CoV-2 for future protection, what happens in the immune system to cause poorer outcomes with COVID-19? Let’s look at the innate and adaptive immune system in this situation.
Abnormal Innate Immune Response
First, suppose the innate immune system is not functioning correctly due to chronic illnesses, such as obesity, type II diabetes and cardiovascular disease. In that case, patients can experience the well-known “cytokine storm”.
A “cytokine storm” results from a sudden acute increase in circulating levels of different pro-inflammatory cytokines including TNF-a, IL-6, and IL-1b. Think of it as meta-inflammation in action, and way too many marines going to the site of infection causing huge collateral damage. The cytokine storm can cause lung injury, viral sepsis, pneumonitis, ARDS, respiratory failure, shock, and organ failure.
Abnormal Adaptive Immunity
Second, in response to the cytokine storm, the adaptive immune system can also go awry. Lower numbers of T cells, such as CD4 and CD8 T cells, have been found in detected in patients infected with SARS-CoV-2 with worse outcomes. The number of T regulatory (Treg) cells are also significantly decreased in severely ill patients. Regulatory T cells are vital in the maintenance of immune homeostasis: a balanced and effective immune response.
Lifestyle Medicine Implications
Understanding healthy and abnormal immune responses to COVID-19 is important. It enables us to stand back from the noise and establish our risk factors, and take control of certain lifestyle variables accordingly.
For most, poorer outcomes with COVID-19 occur in those individuals who are already experiencing high levels of inflammation. COVID-19 and the cytokine storm is a meta-inflammation process. When you look for a common theme linking obesity, cardiovascular disease, COPD and other groups of people with poorer outcomes with COVID-19, it is the preexistence of chronic inflammation.
For example, CRP (a common generalised inflammatory marker that shows up on any blood test with your GP/doctor) quite literally predicts COVID-19 outcomes. The odds ratio of someone with high CRP being admitted to ICU in the hospital is 7.09. This is not something to be scared of: it is something to take action on.
Preventative lifestyle measures have never been more critical in helping our immune system manage COVID-19 infection. Given that the virus is now endemic in society and here to stay, proactive wellness takes on new levels of importance.
Diet, exercise, and other anti-inflammatory lifestyle changes can have a transformational effect on risk factors with COVID-19. This insight should be celebrated and shared, especially given the existing mental health crises caused by fear and a perceived lack of control.
Gut Health: Research shows that the higher the levels of a circulating pro-inflammatory cytokine called IL-6, the worse the outcomes for COVID patients. Lifestyle-induced imbalances in the gut are triggers for IL-6. Excess stress, a high-fat diet and too much alcohol can trigger dysbiosis and increase circulating IL-6.
Probiotics may be an important weapon in helping individuals to successfully adapt to SARS-CoV-2 infection. This can be seen below from a recent paper addressing the potential effect of Lactobacillus rhamnosus CRL1505:
Diet: It well established that a whole food nutrient-dense diet reduces chronic low-grade inflammatory markers across the board. Working from home provides each of us with the opportunity to eat more wholesome foods to look after our immune resilience.
If you are interested in learning about potential strategies to improve your nutrition to support immune resilience during this time, this is a useful research paper.
Exercise: Research also shows that exercise helps to reduce chronic inflammatory markers, such as CRP, thereby improving the chances of a positive outcome after SARS-CoV-2 infection.
Measure Resilience | Surface Insight | Empower Teams
To learn how 360 can help you improve the health, resilience and productivity of your employees, get in touch today.
The Importance of Gut Health in the Treatment of COVID-19
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360 is dedicated to using evidence-based medicine to proactively inform decision-making in our health. Now, more than ever, it is important we utilise peer-reviewed literature to help us navigate the pandemic on a personal level.
We live at a time of great uncertainty. Rules and regulations that affect our daily lives are changing frequently. The future is unsure. There is currently no clear finishing line to many of the challenges we face at home, at work and in society. However, whilst we cannot control all these factors in the outside world, we can take charge of factors impacting our inner world. Personal wellbeing is central here.
Nutrition is one of the many pillars we can address through small impactful lifestyle changes to look after our wellbeing. It is also an emerging area of interest in the successful management of COVID-19.
More specifically, research suggests that improving the health and diversity of the gut microbiome through a diet lower in saturated fat, higher in fibre and including probiotics may be of value in the pandemic because of the impact the gut microbiota in regulating immune tolerance and the lung microbiota.
As the authors of this paper put it:
Gut microbiota diversity and the presence of beneficial microorganisms in the gut may play an important role in determining the course of this disease. Elderly, immune-compromised patients and patients with other co-morbidities like type-2 diabetes, cardiovascular disorders fare poorly in combating Covid-19. It is interesting to note that a general imbalance of gut microbiota called “dysbiosis” is implicated in such patients and the elderly
A recent Research Review looked at the potential impact of the gut microbiome in determining outcomes of COVID-19 infection. The gut microbiota refers to the trillions of microorganisms that live inside the gastrointestinal tract, and collectively it plays a central role in regulating immune and brain function. For a deep review of the topic, this is a very good research paper by leaders in the field.
The current paper, entitled “Potential contribution of beneficial microbes to face the COVID-19 pandemic“, addressed biological mechanisms by which a healthy and diverse gut microbiota appears to be central in successfully regulating our immune responses to COVID-19 and helping to prevent the hyper-inflammatory “cytokine storm”.
The “cytokine storm” has been shown to be a key determinant of outcomes with COVID-19. Therefore, if there are proactive lifestyle medicine tools that can be used to reduce the risk of negative outcomes, it is worthy of note. This research review in question builds on the weight of research from evidence-based medicine and postulates that dysbiosis (an imbalance in the gut microbiota) is a risk factor in COVID-19 outcomes.
Simply put, an unhealthy and imbalanced gut appears to put an individual at greater risk of a “cytokine storm” and pathology within the lungs after infection by SARS-CoV-2. This risk is chiefly caused by the fact that dysbiosis promotes a release of pro-inflammatory cytokines in the gut which impairs the integrity of the lining of the gut, thereby increasing the chances of a cytokine storm within the lungs. The image below illustrates these mechanisms at play:
As you can see in the image there is a gut microbiota and a lung microbiota. An imbalance in the gut microbiota caused by poor diet sets up a chain of pro-inflammatory events in the body that affect the lung microbiota and can contribute to the cytokine storm.
As the authors of the paper postulate:
Dysbiosis in the microbiome may create an inflammatory environment that the coronavirus can exploit. Gut-related inflammatory proteins, cytokines, are amplified by more cytokines when coronavirus hits. The combined inflammation may ignite a “cytokine storm”—a runaway immune reaction that can cause more damage than the virus itself, including multiorgan injury.”
At 360, we have a distinct philosophy in all of our work which is to be proactive and treat the cause, not the symptom. We focus on positively impacting the first domino rather than reactively chasing the fifth.
In this instance, it is important that hospitals use various anti-inflammatory medications to manage the cytokine storm once it hits, but from a preventative medicine standpoint, our interest is in helping people ahead of time prevent the cytokine storm in the first place if they become infected with SARS-CoV-2. The gut is one key piece of the immune resilience matrix in this respect. This is summarised well in a new research paper which concluded:
The gut microbiome can play a crucial role in modulating the immune responses of COVID-19 infected individual, and prevent the damage of vital organs, including lungs. Therefore, re-formulating the gut microbiota may emerge as a new therapeutic target in the disease management of COVID-19 patients employing nutritional therapy, probiotics or fecal microbiota transplantation (using standard guidelines).
As we approach winter, make gut health central to your wellness programme and that of your employees.
Measure Resilience | Surface Insight | Empower Teams
To learn how 360 can help you improve the health, resilience and productivity of your employees, get in touch today.
Vitamin D in the Treatment of COVID-19
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In recent months, a significant amount of research has been published on risk factors, medical treatments, and lifestyle medicine tools to help in the management of SARS-CoV-2.
There is a matrix of solutions in this respect, and one of those solutions to mitigate risk and effect is nutrition. A new study from August 2020 looked at the potential role of Vitamin D in the treatment of patients hospitalised with COVID-19.
Entitled “Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study”, this paper is worthy of mention.
Vitamin D is an inexpensive supplement with few contraindications at the appropriate dose, and with winter coming, the results have important implications in protecting our health.
Design Set-Up
There were 76 participants in the trial; all hospitalised with COVID-19. The average age of patients was 53, and at the start of the study, there were no significant differences in the number of subjects with at least one risk health factor.
Results
Of the 50 patients treated with Vitamin D, only one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%).
Of the patients treated with Vitamin D, none died, and all were discharged, without complications. Of the 13 patients admitted to the ICU who were not given Vitamin D, two died.
Implications
This trial into the therapeutic effect of Vitamin D is the first study of its kind. More well-controlled RCTs are currently taking place, and they are needed to add confidence to the data. But the results of this study are very encouraging.
Mechanisms of Success
From a biological perspective, why might Vitamin D help patients recover from COVID-19?
Research suggests the Vitamin D works through multiple mechanisms. These include:
1) Decreasing the cytokine and chemokine storm
2) Regulating the renin-angiotensin system
3) Maintaining the integrity of the epithelial barrier in the lungs
4) Stimulating the repair of the epithelial barrier in the lungs
5) Modulating neutrophil (immune) activity
The image above provides a visualisation of these potential mechanisms. As the study concluded,
“Coronavirus infection is a serious health problem awaiting an effective vaccine and/or antiviral treatment. The major complication of SARS-Covid-19 pneumonitis is ARDs (Acute Respiratory Distress syndrome) mediated by a variety of mechanisms that may be aggravated by vitamin D deficiency and tapered down by activation of the vitamin D receptor.
We would add that even in the presence of a vaccine, the virus is endemic and not all parts of the population are going to receive or take up the opportunity of a vaccine. As such, it is important to get ahead of the curve and find ways to protect our health ahead of time. Vitamin D status is one of the multiple avenues to help optimise immune resilience.
As we approach winter, ensure you optimise vitamin D for yourself and your employees.