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With Risk of Reinfection, Is COVID-19 Here to Stay?

Published online by Cambridge University Press:  27 July 2020

Parnian Jabbari
Affiliation:
Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
Nima Rezaei*
Affiliation:
Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
*
Correspondence and reprint requests to Nima Rezaei, Children’s Medical Center Hospital, Dr. Qarib St., Keshavarz Blvd., Tehran14194, Iran (e-mail: rezaei_nima@tums.ac.ir or rezaei_nima@yahoo.com).
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Abstract

Type
Letter to the Editor
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© Society for Disaster Medicine and Public Health, Inc. 2020

Many factors have served the swift transformation of the coronavirus disease (COVID-19) from an endemic to a pandemic. Reference Hanaei and Rezaei1 Some can be attributed to characteristics of the virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), such as high basic reproducing number (R0) of about 2 to 6 and transmissibility despite absence of clinical manifestations. Reference Randolph and Barriero2 However, our assumptions about the pandemic, most of which are falsified or questioned, at this point, also played a major role. One such assumption was that SARS-CoV-2, similar to H1N1 virus, will attenuate in high temperatures, while we are now observing the second wave of the pandemic in some countries, despite rising temperatures. Another assumption was reaching herd immunity for SARS-CoV-2 as the number of the affected individuals would rise, thus restrict the transmission of virus due to the increased number of immune hosts and decreased number of susceptible ones. Reference Randolph and Barriero2 However, a key concept in establishing and maintaining herd immunity is a strong immunization against the pathogens which lasts long enough so that the fraction of the population immune to the virus surpasses the herd immunity threshold. Therefore, persistence of immunoglobulin concentrations is one of the factors that determines the possibility of reaching herd immunity or periodic outbreaks. Reference Randolph and Barriero2

In the majority of individuals infected with SARS-CoV-2, neutralizing immunoglobulin (IgM and IgG) levels rise within days to weeks of symptom onset. Reference Lotfi and Rezaei3 These antibodies have reported to produce immunity to reinfection in primates re-challenged with SARS-CoV-2 at 28 days after the initial infection. Reference Kirkcaldy, King and Brooks4 However, unlike many other respiratory viruses resulting in immunoglobulin concentrations that last for several months, neutralizing immunoglobulins against SARS-CoV-2 persist for about 40 days. Reference Kirkcaldy, King and Brooks4 On the other hand, positive RNA tests, despite seropositivity for IgG after primary infection, have been reported. Reference Roy5 Even though such cases have been interpreted as silent carriers or low reliability for the commercially available kits and sampling errors, the time window between the primary infection and the second positive RNA test, which is about 2 months, in some cases, can be suggestive of reinfection with the virus, or reactivity of a latent infection with SARS-CoV-2.

Even though studies are promising for an effective vaccine in the next 12 to 18 months, Reference Randolph and Barriero2 the presence of more than 80 genotypical variants of the virus, possibility of reinfection, and short duration of seropositivity for neutralizing antibodies raise the concern that vaccination may not result in an effective and long-term immunity against SARS-CoV-2. Furthermore, immunoglobulin levels may not correlate with viral shedding and risk of transmissibility of SARS-CoV-2. Reference Roy5 Also, the short duration of immunity against the virus may not allow for increasing homogeneity of affected populations in a specific time frame. Therefore, herd immunity may not be achieved as reinfection may occur even in the presence of neutralizing antibodies. These factors raise concerns that eliminating the COVID-19 pandemic may not be as feasible as once assumed and that we must rely more on prevention of transmission until more aspects of the virus and its pathogenicity are discovered.

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

References

REFERENCES

Hanaei, S, Rezaei, N. COVID-19: developing from an outbreak to a pandemic. Arch Med Res. 2020;epub. doi: 10.1016/j.arcmed.2020.04.021.CrossRefGoogle ScholarPubMed
Randolph, HE, Barriero, LB. Herd immunity: understanding COVID-19. Immunity. 2020;52(5):737-741.CrossRefGoogle ScholarPubMed
Lotfi, M, Rezaei, N. SARS-CoV-2: a comprehensive review from pathogenicity of the virus to clinical consequences. J Med Virol. 2020;epub. https://doi.org/10.1002/jmv.26123.CrossRefGoogle ScholarPubMed
Kirkcaldy, RD, King, BA, Brooks, JT. COVID-19 and postinfection immunity: limited evidence, many remaining questions. JAMA. 2020;epub. doi: 10.1001/jama.2020.7869.CrossRefGoogle ScholarPubMed
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