OT: Can You Get Covid-19 Again? It’s Very Unlikely, Experts Say.
From the headline you might be expecting a piece from One America News. I'd understand. But, no, it's the New York Times:
https://www.nytimes.com/2020/07/22/health/covid-antibodies-herd-immunity.html
Great news if true. I'm no expert and I'll leave the analysis to readers like Sopwith.
You're waking the neighbors, shut up! Let the BPONE wash over you...
The “Nature” report shared in another thread had findings along the same lines. They were finding cross-immunity from other coronaviruses including recovered SARS-1 patients 17 years ago.
There are a lot of terms I don’t understand yet in this report, but from what I can piece together this seems like good news. Others please weigh in.
This is an unedited manuscript that has been accepted for publication. Nature Research are providing this early version of the manuscript as a service to our authors and readers. The manuscript will undergo copyediting, typesetting and a proof review before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers apply.
Should also point out the disclaimer in that article that is not yet published
I'm not sure why you are getting downvoted for this? It's an important detail to note and if not for the global pandemic the public would rarely get access to an unedited manuscript
Archiving preprints is not uncommon, e.g., arXiv. Additionally, it is not unusual for the publisher to have some sort of Early Access or Just Accepted option for publishing the unedited manuscript for the sake of expediting the process.
https://helpfaqs.acs.org/2008/12/19/frequently-asked-questions-about-just-accepted-manuscripts/
That said, I don't believe Nature typically offers such an option.
Concur - this sounds more like a "galley proof" stage.
It certainly does not mean it has not been peer-reviewed.
I was just about to point out the same thing-- it sounds like a galley, not a pre-peer review manuscript.
Correct. The content should not change. Typically authors are given a final chance to correct any typos and then the publisher will format it. For example, in this case all the figures are at the end rather than integrated into the text, which is typical formatting for manuscripts for review.
Yep fair point. Thanks for calling that out.
I'm not a virologist, but Memory-T cells seem to work in remarkable ways --- there is apparently enough similarity between THIS coronavirus and other coronaviruses that there is a reaction.
Overall, I view that article as good news --- and I've read learned speculation that if/when we do get a vaccine for this coronavirus, that vaccine may have a positive effect in the long-term as regards fighting other coronaviruses.
Safe to assume we can expect a new corona virus requiring a fresh dose every couple years or so? Half joking /s
*Reading this to Bolsonaro and laughing in his face*
Some takeaways from the article I found:
-People who did get "re-infected" were far more likely to have been patients that had delayed expression of symptoms weeks after initial exposure to virus
-Cases of people who lost antibodies after 2-3 months of infection likely inline with body's response to acute or minor infection, doesn't necessarily reduce possibility of vaccine efficacy
That was my same takeaways, and is in line with everything else I have read about those who "appear" to get Covid-19 a second time.
One more that's important because the headline (and post title) is incredibly misleading:
"It may be possible for the coronavirus to strike the same person twice, but it's highly unlikely that it would do so in such a short period of time."
So sure, it's unlikely you can get it again NOW/AT THIS MOMENT (if you've had it) but you will eventually be able to get it again. We just don't know how far out that when is yet.
Good post.
And while we're on the subject, we ALSO do not know what the long term ramifications are of infection.
So the name of the game remains "try not to get sick until a vaccine is available." Even if herd immunity seems possible with SARS-COV2, it doesn't mean we should be stampeding towards it.
So sure, it's unlikely you can get it again NOW/AT THIS MOMENT (if you've had it) but you will eventually be able to get it again.
That's not what its saying. The point is that there is no evidence of reinfection so far. The article is saying that any cases of "reinfection" that were previously reported are unlikely to be true reinfection, but are actually cases of drawn out recovery.
Long term reinfection can't be ruled out entirely, for the obvious reason that no one has had it for that long. But there is no evidence to support long term reinfection outside of bald conjecture.
As someone hoping for long term immunity with a vaccine, I did not find the NYT article as convincing as some on here. It is filled with lots of qualifiers in its language which is understandable because the answers to the question of long term immunity are not yet known.
One of the problems ascertaining what will happen long term is the fact that we are slightly more than seven months into this virus worldwide and slightly more than four months of major contagion in the US. That is just the way it is with virology. Answers about certain aspects just take time.
Even six months of strong immunity from a vaccine or infection followed by sensible national policy could largely reduce this disease to something that could be highly controlled. Look no further than South Korea for an example of what good national policy and people willing to support it were able to accomplish.
This is fantastic news for my public bus handrail licking fetish!!
And I thought I was alone.
This is the most logical answer, as that's how normally how immunity functions.
Now, the virus may ultimately mutate into new strains that can evade our immunity (as our old friend influenza does), but it seems at least that the pace of mutation isn't particularly fast, which is a good thing.
Much more likely to behave like other coronaviruses. Not rapid mutation but reinfection possible after a year or two.
I think the most important thing to remember here is that Ohio State can go to Hell.
of course
Especially if it kills you the first time.
"A little knowledge is a dangerous thing"
So many unknows remain-even to the experts.
Somehow, from somewhere we are going to have to muster up a monumental dose of collective courage. We need to put our best foot forward.
There is a measure of luck in play here. Hopefully skill, knowledge and wisdom will catalyze a sooner as opposed to later answer.
I have not encountered any fear from the medical community-there is much concern.
Don't worry man, I had zero expectations that any useful information would be coming from OAN
Hope this is true. Think I may have it right now.
In that case your username is a bit ironic.
The evidence has been pointing this way for awhile (as regards reinfection in the short- and intermediate- term).
It behaves like most coronaviruses - immunity for awhile, but not forever.
Yeah, I thought the notion of repeated infection soon after recovery had mostly been debunked already, but it can't hurt for the NYT to hammer it home a bit more. What I'm seeing evolve in the public understanding of the immune response is that there's more to it than just the levels of antibodies. We're starting to see an appreciation (in the reporting) for memory B and T cells. Much harder to test for, but also where longer-lasting immunity resides (I tried to emphasize that point in the Neck Sharpies III post).
The only caveat I'd add here (other than what others have pointed about re: longer-term reinfection potentially being a thing) is that there hasn't been an adequate explanation of some false-positive tests. There's been some hand-waving about viral "debris" causing the RT-PCR positivity, but that drives me bonkers-- viral RNA isn't going to last that long without the protection of the viral capsid around it. So that remains a little odd.
Overall, worry about infection number 1. Even if there were isolated cases of legitimate re-infection (probably because of a SARS-CoV-2 strain that is just different enough on the surface to evade triggering the secondary response), that isn't what's going to drive this pandemic train.
EDIT: Weird personal note you didn't need to know-- the scientist quoted in the NYT article, Dan Barouch, dated my ex-college girlfriend. Obviously, she has a thing for, ahem, brilliant men.
hey sopwith, question for you - if the antibody tests aren't very accurate about telling us if we've had covid/still have immunity to it, do you think anything will be developed to test for those memory b and t cells, or is it unrealistic to do on a large scale? i'm one of those people who are looking back at a january illness and wondering if i had it (sickest i've ever been with fever, body aches and cough, negative influenza, treated for pneumonia after a week of misery at home). maybe it's just wishful thinking, but it sure would be nice to know if i was immune for the next year or so. also, if you've answered this in one of your diaries, i'm happy to read it there. thanks for the info you provide.
The test for T lymphocyte reactivity is called flow cytometry. It's a common test for other viral infections such as HIV and uses whole blood specimens. There are no tests among commercial labs that look for SARS-CoV-2 reactivity, apart from a few, specialized research-affiliated ones.
However, with the focus shifting to T cells, I would anticipate that we'll see availability of these tests reasonably soon.
Wellllllllll.... there is a substantial amount of prep for running flow cytometry. And the machines are ungodly expensive, and that's with basic 4-color, I don't even know how many colors they're up to nowadays. Most high-throughput HIV tests are RT-PCR for the viral infection itself and the flow assays are for defining the population of T-cell subtypes.
Customizing it for detecting a memory cell specific for a given antigen is a complex setup-- I'd be interested in hearing how that's done. Scaling it up for widespread use sounds far-fetched to me but sounds like you may have some experience.
This discussion between Sopwith and Njia just cemented for me that these things are WAY over my head, and I have a Ph.D. in Physics (which means nothing here). I've never felt this stupid in my life.
Oh wait, yes I have, when I decided that moving to Columbus in 1999 would be okay.
It's definitely not over your head, it's just unfamiliar. :) Flow cytometry is a complicated/expensive bit of technology but the physics are just basic optics: various dyes absorb at one wavelength and emit at another when excited by lasers, and reading the emission spectrum from each individual cell as it zooms by lets you build up a 2-dimension plot. You'd understand it faster than I did the first time if you were exposed to it.
I agree with your first sentence. I'm an engineer, not a virologist, epidemiologist, or a physician. But I learn as much as I can about things that terrify me (this virus certainly qualifies) in order to be better informed about the risks, and prepared for what I might face if I am unlucky enough to be infected. In the process, I've become more comfortable with and conversant in a great deal of the lingua franca of professionals who study infectious disease, and I've been able to read the peer reviewed research directly, rather than rely on media reports that are often over-simplified and sometimes just wrong.
I wish everyone did this.
Can you honestly say this virus "terrifies" you? That's no way to live, Njia.
It doesn’t terrify need in the sense that I’m living in fear. But I do have some of those often-mentioned co-morbidities that make a serious illness possible in my case. If this was the flu, I know the likely disease progression. It would suck for a few days, then I’d get better and move on. This virus, being novel, introduces the element of the unknown.
.
I'd have to say that I'm VERY closely aligned with where you are, Njia, on my outlook about Covid-19 as it relates to me. I don't know what your co-morbitities are but I know mine: age (60's) weight (I've lost 15 lbs this summer but need to lose 20-30 more, TBH), blood pressure, and medical history of having had bronchitis 4 times, including twice in the last 15 months. On the plus side, I'm an ex-smoker and I exercise daily, mostly cycling 7-20 miles daily and occasionally taking 2-3 mile brisk walks.
Like you, I've tried to read up on as many covid studies as I have time for each week, including a few peer-reviewed studies. And, though I'm not an expert, I'm a helluva lot more knowledgeable than I was 6 months ago on so very much in regards to how the immune system works and the many ways vaccines are developed.
I fully understand the importance of masking-up and social distancing and I schedule and conduct myself accordingly at almost all times with the exception of allowing myself occasional contact with my kids (two of whom had birthdays over the last week) and granddaughter.
Not fear nearly so much as realism and a pragmatic approach to protecting myself and my loved ones.
As far as I'm concerned, though, a vaccine can't get here quickly enough!
Appreciate that response!
The chemists are following right along just like we would in a physics discussion.
Scaling up a test for memory cells would be truly problematic. Maaaaaybe for B-cells, because they can still recognize a target protein in it's "native" state (in this case, they could recognize the intact virus just like a normal antibody). But T-cells, memory and otherwise, recognize targets in a completely different way-- they recognize small bits that are processed and presented to them by accessory cells creatively called "antigen presenting cells." Lab tests can be done, but scaling it up just doesn't seem feasible to me. There's a throughput problem.
Per my comment above, how is flow cytometry done at scale for e.g. HIV?
See, I don't think it is, certainly not at the scale we're talking about. I wouldn't think clinicians would care that much about T-cell specificity for HIV antigens because it's the helper T-cells that are the target of the virus, and the depletion of those "CD4" cells is the hallmark of the pathology. But I'm interested in hearing about it.
My understanding of flow cytometry is based upon my limited understanding of the tests for HIV. From what I've read, it seems like the CD4/CD8 ratio is one measurement of the HIV tests, as well as a number of others including CD4+ T cell count for HIV and a few other viruses. All of these tests are available from commercial labs in a normal test order. Are they suitable to SARS-CoV-2? I'm not sure. Probably not, because if I understood your earlier posts correctly, it's CD8+ that is the Covid-19 gold mine.
I started looking into this because I was interested in finding out if I could get a test for SARS-CoV-2 memory T cells. Like probably everyone else, I'd love to know if I have cross-reactivity based on infection by other HCoVs.
The only lab I could find that even does SARS-Cov-2 specific flow cytometry is this one: https://www.flowcytometryservices.com/covid-19-research-support
Its services are clearly intended for research support, not diagnostic testing at scale.
Oh now I see what you're talking about with HIV flow cytometry. Yeah, that's strictly to assay if the total CD4 ("Helper") T-cell population is dropping relative to total T-cells or as a ratio with CD8 ("Cytotoxic" or "Killer") T-cells. So it's very straightforward-- you take a blood prep, add 1 antibody vs. CD4 and a different one vs CD8, each of which is conjugated to a different color dye so your machine can optically sort one versus the other.
Figuring out the actual specificity of individual T-cells... phew, that's a tough one via flow. With B-cells you could attach a dye to a viral antigen and see how many cells will bind it, but T-cells that is a rough thing to figure with flow assays. Traditionally I think you would use an ELISA setup: you load some antigen (in this case, probably SARS-CoV-2 spike protein) into wells with the antigen presenting cells fixed to the bottom, then you add your diluted, purified T-cells and see what binds. Quantifying it would be really tricky but you'd know if some exist, at least.
It is possible to scale up tests for antigen-specific T cells. Not by flow cytometry, but we have EliSpot type tests (Tb is tested for by "t-spot" or Quantiferon tests that challenge a patient's blood cells with a Tb antigen and see if they react by making stuff). These are widely available in many hospitals all around the world.
Point taken, that's what I was thinking with an ELISA in the comment above, but the tricky part is that with Tb you have a very, very well defined immunogenic peptide that you can use in the assay. With SARS-CoV-2, you know you probably want to use some segment of the spike protein, but they haven't identified which would be the most common/most immunogenic peptide yet. Until they figure that out, at least, I can't figure how it scales up.
EDIT: that Nature paper cited earlier in the thread does show at least a couple of regions of the nucleocapsid (NP) protein that appears to be highly conserved (common) in different coronaviruses and they used an Elispot assay there, so maybe they have enough to go on?