Del Rio C and Malani P have spent many efforts to summarize the
flood of comunications about the most important aspects of the COVID-19-pandemic published in the last five months.
By doing that,they offer a platform for additional thoughts and discussions.I think that it is important to remember how the new coronavirus was „born“.
A doctor, Ai Fen, the chief of the emergency unity at the Wuhan Central Hospital, had to deal with several patients with Pneumonia of unclear origin and had the idea and the opportunity to ask the laboratory of the hospital to test swabs from a patient for SARS-Coronavirus (1).The laboratory had a real-time PCR-kit which could also identify the RNA of several viruses responsible for „atypical pneumonia“ including several betacoronaviruses and SARS-CoV-1 (2).
This was the basis for the sequencing work which was quickly performed by the chinese scientists(2).This would not have been routinely possible in many other hospitals in western countries.
As pointed out by Caterine Paules, Hilary Marston and Anthony Fauci(3) in their viewpoint,human Coronaviruses belonged to a family of now seven components which have a large sequence similarity.With the exclusion of SARS-CoV-1 and MERS the other four HuCoV are responsible for 10-30% of atypical pneumonias every winter around the world.These viruses use the same receptor(4) the new CoV uses to colonize the human upper and lower airways.This means also that antibodies against those viruses are quite common in the sera of many persons(5) and we do not exactly know how COVID-19-specific the antibodies are which we are measuring in the sera of COVID-19 infected patients (6).
Serum level of neutralizing antibodies (7) will also decrease with time (8,9) and their presence does not mean that they will help to clear the virus and to prevent reinfection (10,11).
Under these conditions (6) and considering the not so positive past experience performed with the influenza vaccine (12,13) the production of a COVID-19-vaccine represents a true challenge.
As we have recently learned that the pulmonary disease without thrombosis of the pulmonary vessels, is mainly responsible for the death of elderly COVID-19-patients with several comorbidities (14),while other organs supposed to be invaded by the virus(15), seem not to be much damaged, efforts should focus on early supportive care and therapy to avoid development of severe respiratory insufficiency.Autopsy of the patients who died of the disease is still a priority especially in academic centers.
1.Kuo L: Coronavirus:Whuan doctor speaks out against authorities.The Guardian 2020,March 11.
2.Zhu N,Zhang D, Wang W et al.A novel Coronavirus from patients
with pneumonia in China,2019 New Engl J Med2020;382:727-733.
3.Paules CI,Marston HD,Fauci AS.:Coronavirus Infection-More than just the common cold.JAMA2020;January 23:E1-E2.
4.Wu K,Li W,PenG G. Li F.:crystal structure on NL63 respiratory coronavirus receptor-binding domain complexed with ist human receptor.Proc Natl Acad Sci.2009;106(47):19970-19974.
5.Gorse GJ,Patel GB, Vitale JN,O`Connor Z.:Prevalence of antibodies to four human coronaviruses is lower in nasal secretions than in serum.Clin Vaccine Immunol 2010,17(2):1875-1880.
6.Eder S,Twohey M,Mandavill A.:Antibody test,seen as key to reopening country,does not yet deliver.The New York Times2020 April 10
7.Wölfel R, Corman VM, Guggemos W et.al.Virological assessment of hospitalized patients with COVID-2019.Nature 2020 April 1.
8.Du Z, Zhu F, Guo F et al.Detection of antibodies against SARS-CoV-2 in patients with COVID-19.J Med Virol 2020:1-4
9.Lin Q,Zhu L,Ni Z et al.:Duration of serum neutralizing antibodies for SARS-CoV-2:lessons from SARS-CoV infection.J Microbiol,
10Chen D, Xu W Lei Z et al.:Recurrence of positive SARS-CoV-2-RNA in COVID-19:A case.Int J of Infec Dis 2020;93:297-299.
11.Lan L,Xu D, Ye G et al. Positive RT-PCR test results in patients recovered from COVID-19.JAMA 2020;323(15):1502-1503
12Simonsen L, Reichert TA, Viboud C et al.:Inpact of influenza vaccination on seasonal mortality in the US elderly population.Arch Intern Med 2005;165:265-272.
13.Choe EJ Rolfes MA,O`Halloran A et al.Respiratory and non-respiratory Diagnoses associated with influenza in hospitalized Adults:JAMANetwork 2020March 20
14.Horowitz J.:Surviving Covid-19 May not feel like recovery for some.New York Times 2020 May 20
15.Schaller T, Hirschbühl K Burkhardt K et al.Postmortem examination of patients with COVID-19.JAMA 2020,May 21
A part of this article as been published in part as a comment to the vewpoint: Translating Science on COVID-19 to Improve Clinical Care and Support the Public Health Response, published online in the Journal of American Medical Association May 22 2020 by Carlos del Rio,and Preeti Malani