The Song of the Cell: An Exploration of Medicine and the New Human

by Siddhartha Mukherjee

The cellular “hijack” involves an uncannily devious trick: even as it converts the cell into a factory to produce millions of virions, SARS-COV2 stops the infected cell from secreting type 1 interferon. At Rockefeller University in New York, Jean-Laurent Casanova converged on the same conclusion: the most severe cases of SARS-COV2 infection, he found, occurred in patients—typically men—who lacked the ability to elicit a functional type 1 interferon signal after infection. At times, cell biology produces the most peculiar and unexpected of results. These men with severe Covid had preexisting auto-antibodies against type 1 interferon—i.e., their bodies had attacked and rendered the protein nonfunctional even before they had been infected. These patients were already deficient in the type I interferon response—but were unaware of their deficiency until the virus struck. For them, Covid infection had unveiled a long-standing, but previously invisible, autoimmune disease—a dormant, unknowable horror autotoxicus (against type 1 interferon, the viral alarm bell) that was only revealed by SARS-COV2 infection.