The Ministry of Health added reinfections to the list of suspected cases of coronavirus

Irene Hartmann

11/18/2020 5:16 PM

• Clarín.com

• Society

Updated 11/18/2020 5:16 PM

We have been putting

coronavirus

under the rug

.

We use the arguments that we can: 1) "

", 2) "

", 3) "it

".

The evasion serves to kick the difficulty.

But come back.

Now, the Ministry of Health of the Nation itself put the matter on the table, with a pdf entitled "

", something like the "officialization" that the reinfections exist.

The text adds to the general protocol for managing the pandemic in the country.

The new definitions are “

” (with its variants “probable” and “confirmed”) and, also, “

”.

For now (because the whole issue is in "we will see"), the difference between these labels lies in a time cut that some experts are already questioning. 

According to Health, if the box is restarted

will be considered a suspect of "viral reactivation."

If it happens later it could be a "reinfection".

The viral reactivation thing seems new.

Who with infinite patience clarified these questions to

was

, an expert in virology, Principal Investigator of the UBA-Conicet at the Institute for Biomedical Research in Retroviruses and AIDS (INBIRS).

“If you were to look at the movie of the virus detection by PCR, in these

we should plot a

' separated by a period of -at least- 45 days.

Each peak would be a genome-detectable PCR.

The coronavirus can reduce its replication to very low levels, so it could temporarily not be detected by laboratory methods, "he explained.

What does Health say about the chances of having a second coronavirus picture?

The text starts from the premise that “all over the world” reported cases “of positive RT-PCR for SARS-CoV-2, after the clinical recovery of an initial episode and the presence of at least two negative tests for RT -PCR, during the convalescence period ”.

They cite

: two from the United States, one from Hong Kong, one from Belgium, two from India and one from Ecuador.

In all there was a "first" and a "second" time.

Five were symptomatic the first time, and two were asymptomatic.

In the second round, the asymptomatic patients remained the same;

while one of those who had been symptomatic manifested the disease without symptoms, and the rest, symptomatic in the first round, suffered the virus, the second time, more severely.

How to interpret these sequential episodes?

The text of Health explains that, or they are a sample that some CRP give false negative;

o evidence cases of viral reactivation;

or they are reinfections.

Slippery terrain

Before continuing, a couple of important concepts that we will present in a simplified way, without the infinite grays that seem to dominate everything.

There are basically

: 1) that after the first infection the organism “fails” and does not generate a robust immune front that allows it to defend itself the next time (or that it generates it, but the armor weakens or, directly, disintegrate), and 2) that the virus reappears "in disguise" and deceives our organism, which Quarleri likes to tell using a football metaphor: "As if he were wearing the shirt of the same team, but with another number".

The truth is that the immune system is a complex parallel world.

On the one hand, there is the innate immune response, which has no "memory" and is the closest thing to the acidity that the stomach generates to kill microorganisms in food.

Then there is the one that matters to us in this pandemic: the

, which splits into two “arms”.

The first is the

, which is in the "humors", the fluids of the body.

“The effector that carries out this immunological action are antibodies, soluble proteins that travel in our fluids.

participate in this process

”, explained Quarleri.

On the other hand are

, which mediate the

.

"These T lymphocytes then 'help' the others, the B lymphocytes, which are involved in the generation of antibodies," he added.

If it makes sense to give so much detail, it is because the Health text focuses on those responses (humoral and cellular) and displays provisional conclusions based on a fact that seems central: some people develop a good humoral response;

others, a good cellular response;

others a little of both ... and others, nothing.

The most discouraging conclusion of the pdf is that "the concentration of

over time, particularly in those who develop

infections

."

It is explained that “

the magnitude of the immune response mediated by B lymphocytes would be related to the severity of the infection;

subjects with episodes of first mild or asymptomatic infection have

compared to those with more severe symptoms ”.

But everything is in "we will see."

Quarleri was crystal clear: “Our anxiety is evaluating the response in months.

.

We can accelerate some processes (such as the development of a vaccine), but we cannot ask the same of the immune response: it does its job in each individual according to their timing ”.

Thus, he noted, while it is not crazy to suppose that "individuals who experience asymptomatic infections would mount a

than those who experience a more serious disease," it must be considered that

the duration of immunity at population scales or the severity of repeated infection ”.

Protocol 

While it is undeniable that reinfection is a "green" issue, some protocol needed to be drawn up, in order to guide the personnel involved in dealing with these cases. 

How will a person be defined as a “

”?

Salud recommends putting that "label" on someone who had coronavirus, was cured and obtained a couple of negative PCRs, but after 45 days or more, without clear symptoms, they again have a positive PCR.

If, in addition to the positive test, he has symptoms compatible with Covid, it will be seen as "

reinfection".

And to be labeled as "

", the requirements are not few: a) have compatible symptoms, b) a positive PCR, and c) laboratory studies that, by comparative genomic analysis of SARS-CoV-2 of the first and second episode , show the presence of different variants, lineages or strains of the virus.

Sounds good, but everything is under study.

The information is contradictory.

Not even Quarleri could confirm that reinfections are only caused by variants of the coronavirus.

Those of which the body has no memory.