Italians say promise of antibodies remains elusive for now

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ROME – Cooperated, mad and desperate for their lives, many Europeans and Americans have seized antibodies and their promise of potential immunity from the coronavirus as the golden ticket to reopen societies and economies.

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Not too long ago, politicians in Italy – who, as the epicenter of the contagion of Europe, are more advanced in the cycle of the pandemic than other western countries – proposed to issue licenses to those who had beaten the virus and developed the right antibodies to get back to work.

Researchers and politicians in China, the United States, Germany, Britain and beyond have clung to antibodies as a potential solution to the virus and to evade containment measures.

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But this discourse, always ahead of science, has become more discreet in recent weeks. With research refusing to cooperate, Italian experts say the promise of antibodies may not be what people have imagined. At least for now.

“We do not know if everyone who has had the disease has developed acceptable protective immunity,” said Dr. Alessandro Venturi, president of San Matteo Hospital in the city of Pavia in Lombardy. The hospital has validated the antibody test used to map the virus in Lombardy, the most affected region in Italy.

Infected people develop different amounts of antibodies, and researchers are still studying the level of protection and the duration.

“We don’t know how long they last,” said Dr. Venturi. “” This is the focal point. “

This is tough news not only for Italy, which released its lock on Monday, but for the rest of the world.

The Italian government will soon begin testing 150,000 people for the antibodies in a “sample survey of the spread of the infection,” according to its website.

Many regions, including Lombardy and Veneto, are still making such projections. But while last month the presidents of these regions promoted the idea of ​​licensing members of an immune workforce, they have now downgraded the panacea tests to a research tool.

“Immunity licenses are just trash,” said Mario Plebani, the coordinator of antibody tests for the Veneto region.

Politicians and experts have tried to lower expectations. But that has not stopped citizens, desperate to know if they have had the virus and are protected against it, and businesses, eager to return to normal, to rush towards the detection of antibodies.

Many local companies have paid for workers to get tested so they can return to work if they test negative for the virus or test positive for the antibody.

Dr. Venturi said the tests were essentially “unnecessary” because they did not describe whether a person had the right level of antibodies and because no one knew how long they would last.

Some virologists have expressed concern that all the hype surrounding antibodies will lead to bad behavior in those who consider themselves invincible, leading to more infections.

“I am very concerned that the irresponsible use of serological tests will jeopardize phase two,” said Italy’s leading immunologist, Dr Alberto Mantovani, who started the reopening of Italy last week. Sky TV TG24.

But Dr. Venturi said antibodies capable of neutralizing the virus still have important functions, including developing plasma that could help patients, and retain the potential for breakthroughs that could eventually help Italy to reopen more fully.

His Humanitas research hospital near Milan treated the first known coronavirus patient in Italy and has extensive experience with the virus. He looked at the 2 to 3 percent of people in the region who show that swab tests are actively infected but whose blood also contains antibodies – known as immunoglobulin G or IgG antibodies – that should neutralize the virus. In other words, these people are no longer contagious.

In these cases, said Dr. Venturi, the virus did not replicate and caused a larger infection.

“It means it’s not contagious,” he said, adding that the hospital’s study is intensifying as researchers search 200 of these cases across Lombardy, where they estimate that 10% of the approximately 10 million inhabitants have contracted the virus.

Locating these cases has not been easy given the rarity of finding someone who has both the desired antibodies and the virus.

The results will take weeks more, but if confirmed, he said, it would show that people who test positive for an adequate level of neutralizing IgG antibodies do not pose a danger of contagion.

In theory, even these lucky few would not have to wait for two consecutive negative swabs – which sometimes take months – before being released from quarantine and allowed to return to work. “It would be like a negative test result,” he said.

In the meantime, however, Dr. Venturi said it was impossible to envision a work force made up entirely of people with neutralizing antibodies.

Instead, he said, Italy’s reopening phase must rely on uninfected people, whom he considered 90% of the population, and on social and other protective measures.

Slideshow by photo servicesSpeaking of immunity licenses, he said, politicians have “gotten ahead of themselves”.

Last week, the office of the President of Lombardy, Attilio Fontana, who predicted that immunity licenses would be in place by April 21, said that everyone still had to follow the recommended lockdown measures.

“There is no license for immunity,” said Giulio Gallera, the region’s top health official.

Yet while some mayors continue to promote antibody testing as a possible way out of the lockdown, people have waited hours in the gym for their blood to be drawn.

Paolo Passaggio, 45, an exporter of household appliances, jumped at the chance when the mayor of his small town in Lombardy, Robbio, recently proposed an antibody test.

“I did it to free myself from this doubt,” said Passaggio, who had symptoms of Covid-19 last month, including a low fever. Unable to get tested for the virus, the swabs being generally reserved for hospitalized patients, he took precautions to avoid infecting others, in particular by remaining isolated for weeks.

Last Tuesday, he got the results: high levels of the immunoglobulin G antibody, or IgG. Passaggio said he understood from doctors on television that it meant a certain degree of immunity, confidence that he was not a danger to others and that he could possibly “go to work before someone ‘another’.

Health experts say it is unclear. But in any case, Passaggio said he had no plans to dramatically change his behavior. When he aimed to see his elderly parents for the first time in months, he expected to stay in the yard and wear a mask.

Some mayors of Italy, furious that the screening of the virus was not more widespread, maintain that the screening of antibodies is important on the psychological, scientific and practical planes. They hoped that immunity licenses would be available to those with the right antibodies.

“We were the pioneers,” said Roberto Francese, the mayor of Robbio, who started testing in April. “Now everyone does it. “

Francese said that a month ago, 50 people in the city had obvious symptoms of the virus, but health officials had failed to test them. They fell ill, then their relatives fell ill and the number of cases increased.

The city, in desperation, has found the serological tests offered by a Chinese factory which, according to the mayor, had an accuracy rate of 96%, and which, according to him, was approved by the Italian national research center.

Robbio has already tested about half of its residents and found and isolated many positive cases, about half of which had symptoms, he said. He also said that tests had shown that 12 percent had IgG antibodies.

He said he considered those people “immunized and would therefore be eligible” for a possible immunity license, despite the doubts of health experts.

Mayor Luca Dure ’of Cisliano, also in Lombardy, said tests showing the presence of protective antibodies” would determine a kind of license of immunity “at some point in the reopening phase starting Monday.

“We don’t know how long, but surely for a few months they can stay in the blood for a year or two,” he said, calling it “surely a positive thing”.

Even someone with IgG antibodies has to act responsibly, said Dure.

“It’s not like someone can go to the theater or dance at the nightclub,” he said, but people could feel some security.

“We cannot wait any longer,” he said.

Emma Bubola contributed to the Milan report.

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