key: cord-0950351-iugcbk9m authors: Makedonas, George; Mehta, Satish K.; Scheuring, Richard A.; Haddon, Robert; Crucian, Brian E. title: SARS-CoV-2 Pandemic Impacts on NASA Ground Operations to Protect ISS Astronauts date: 2020-09-21 journal: J Allergy Clin Immunol Pract DOI: 10.1016/j.jaip.2020.08.064 sha: cd66dca4b02f268ca1bb1336f16d4b67fb759f2f doc_id: 950351 cord_uid: iugcbk9m NASA implements required medical tests and clinical monitoring to ensure the health and safety of its astronauts. These measures include a pre-launch quarantine to mitigate the risk of infectious diseases. During space missions, most astronauts experience perturbations to their immune system that manifest as a detectable secondary immunodeficiency. Upon return to Earth, after the stress of re-entry and landing, astronauts would be most vulnerable to infectious disease. In April 2020, a crew returned from ISS to NASA Johnson Space Center in Houston Texas, during the SARS-CoV-2 pandemic. Post-flight quarantine protocols (both crew and contacts) were enhanced to protect this crew from SARS-CoV-2. In addition, specific additional clinical monitoring was performed to determine post-flight immunocompetence. Given that COVID-19 prognosis is more severe for the immunocompromised, a countermeasures protocol for spaceflight suggested by an international team of scientists could benefit terrestrial patients with secondary immunodeficiency. urgent task was now to augment standard operating procedures to ensure the health and 78 safety of the astronauts from SARS-CoV-2 infection and morbidity. 79 Immune Compromise in Astronauts 80 Physical and psychological stresses cause immune alterations, and these factors may be 81 significant contributors to a compromised immune state associated with spaceflight. Data from 82 studies of students during exam periods and military cadets during training, as well as studies of 83 individuals participating in Antarctica winter-over missions, indicate significant immune effects 84 from psychological stress 2, 3, 4 . A vast evidence base demonstrates that dysregulation of the 85 human immune system is associated with spaceflight 5, 6 . T cell, natural killer (NK) cell, 86 monocyte, and neutrophil function diminish during and/or following spaceflight 7, 8, 9, 10, 11 . increase during planned deep-space exploration missions, thereby increasing crew clinical risk, 100 a discussion of immunological countermeasures for spaceflight has ensued 23, 24 . Timeline: How coronavirus got started Stress and 253 the memory T-cell response to the Epstein-Barr virus in healthy medical students Immune 256 sensitization during 1 year in the Antarctic high-altitude Concordia Environment Antarctic isolation: immune and 260 viral studies Could spaceflight-associated immune system weakening preclude the expansion of 263 human presence beyond Earth's orbit? Mechanistic 266 Clues to Overcome Spaceflight-Induced Immune Dysregulation The effect of space flight on human cellular immunity Immune function during space flight Microgravity and immune responsiveness: 273 implications for space travel Alterations in adaptive 276 immunity persist during long-duration spaceflight NK cell function is impaired 281 during long-duration spaceflight Effects of mission duration on neuroimmune responses 284 in astronauts Adrenocortical and immune responses following short-287 and long-duration spaceflight The role of cytokines in immune changes induced by 290 spaceflight Effect of space flight on cytokine production Plasma 294 cytokine concentrations indicate that in vivo hormonal regulation of immunity is altered 295 during long-duration spaceflight Epstein-Barr virus shedding by 299 astronauts during space flight Latent 302 virus reactivation in astronauts on the international space station Reactivation 306 of latent viruses is associated with increased plasma cytokines in astronauts In vivo testing confirms a blunting of the human cell-mediated 310 immune mechanism during space flight Incidence of 313 clinical symptoms during long-duration orbital spaceflight A case of 317 persistent skin rash and rhinitis with immune system dysregulation onboard the 318 International Space Station System Dysregulation During Spaceflight: Potential Countermeasures for Deep Space 322 Exploration Missions. Front Immunol Immunologic Countermeasure Protocol for Deep-Space Exploration Missions Clinical and immunological 330 features of severe and moderate coronavirus disease 2019 Predictors of Mortality for 334 Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study Persistence and clearance of viral RNA 338 in 2019 novel coronavirus disease rehabilitation patients Functional exhaustion of antiviral 342 lymphocytes in COVID-19 patients Mehta 347 S. Countermeasures-based Improvements in Stress, Immune System Dysregulation Latent Herpesvirus Reactivation onboard the International Space Station -Relevance for 349 Deep Space Missions and Terrestrial Medicine