Distinguishing between reinfection and alternative phenomena is not easy and relies on epidemiological analyses ( including clinical case history assessment ) and virological data ( nucleic acid amplification testing and comparative genome analysis ) to rule out persistent viral RNA shedding and possibly recrudescence .
• for cyclical reinfection ; and infection results in protective immunity that removes any possibility for reinfection . However , the situation is inherently more complicated . To address the SARS-CoV-2 reinfection conundrum , it is necessary to revisit how long and how well the immune responses are protective against SARS-CoV-2 , and differentiate re-infection , re-detection , and recrudescence .”
The re-infections of some people as well as the deaths of fully vaccinated individuals have made recent headlines and serve to alarm the public further . Recent studies have shown the presence of protective antibodies for approximately six to eight months , and epidemiological analyses have reported natural immunity protection from re-infection for at least six to 12 months . The authors point out that “ Protection could go beyond these estimates because of the complexity and robustness of immune responses , though it is also acknowledged that the induction and durability of immune responses — both humoral and cellular — are heterogenous across individuals and may be shorter in some . As an uncommon feature of SARS-CoV-2 , reinfections are expected when immunity wanes or pathogen ’ s antigenicity evolves leading to immune evasion … The limited diagnostic data available from the first wave of infections as well as the supportive evidence required to publish descriptions of re-infections has impacted our appreciation for the frequency of these events . More recently , large observational studies on re-infection have been published . A large , multicenter cohort study among HCWs in England reported an 84 percent lower risk of infection with a median protective effect observed seven months following primary infection .”
Overall , experts hasten to add that there has only been a small number of confirmed re-infections among the tens of millions of SARS- CoV-2 infections worldwide to date , making this phenomenon “ an exceedingly rare occurrence ,” Escandón , et al . ( 2020 ) note . “ Although rare , publication of re-infections is biased toward the diagnosis of symptomatic cases , with asymptomatic cases likely underreported . Reasons for this are the testing eligibility criteria and the lack of resources and rigorous surveillance in many places , except for routine community testing scenarios such as airports and healthcare settings .” They add that while re-infection and recrudescence appear to be infrequent events , they cannot be dismissed altogether as simple errors or sensitivity issues in current diagnostic technologies . Distinguishing between re-infection and alternative phenomena is not easy and relies on epidemiological analyses ( including clinical case history assessment ) and virological data ( nucleic acid amplification testing and comparative
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underrepresented populations and about neglected diseases . This is good for business and private economy , but it undoubtedly does a disservice to science and public health .
HHM With so much data coming out of the pre-print repositories and the journals , is there a concern that implementation science – the translation to the bedside – will suffer due to information overload ? Haven ’ t clinicians always had to vet the science in the literature and apply it sooner than the official guidelines ever sanctioned these interventions ? How is this all being managed during the pandemic ?
Kevin Escandón : I think preprints bring good and bad things and how we predominantly use them will determine whether they are beneficial or deleterious in the end . I think that implementation science has predominantly ( not always ) be based on peer-reviewed , high-quality , and consistently published data . If we keep those criteria , preprint servers would cause expected pressure and public confusion ( as happened with ivermectin when low-quality works and preprints were unfairly communicated to the public ). But let ’ s say that decisions at the top or by scientific organizations would be less likely to be affected . There are of course , these outliers of people , that despite qualifications and fame in some fields ( even Nobels ) make the healthcare policy panorama messy and cause incredible damage to our quality systems and procedures .
HHM Critical thinking skills and discernment must be applied to the entirety of the medical literature ; how can clinicians improve their analytical skills to be able to appreciate the nuances you reference , when they are so busy with multiple competing priorities ?
Kevin Escandón : I think all should start with lay education ( across all ages and lives of all people ) on key aspects such as social determinants of health , inequities , critical reading , scientific discussion of different viewpoints , science principles , and sociology and anthropology background . Unlike beliefs , science seeks the truth based on agreed and valid methods . However , medical science alone is insufficient to advance humankind without the recognition of social science . For healthcare experts , there are wide gaps in knowledge of social sciences . The problem of the lack of knowledge or training to appraise scientific evidence is just the tip of the iceberg , what about the rest of the iceberg — the considerations for implementation of science in society ? It ’ s inherently complex .