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Asymptomatic COVID-19 Cases May Have Weaker

Immune Responses
A SARS-CoV-2 infection can result in a wide spectrum of symptoms, from asymptomatic to
gravely ill. The majority of people infected with SARS-CoV-2 experience a mild to severe
respiratory illness with symptoms that include fever, cough, and shortness of breath—
appearing 2–14 days after exposure. However, other infections remain asymptomatic. Neither
the clinical features nor the immune responses of asymptomatic cases have been well described.
The difference in the severity of the disease is a matter of intense research. Some hypotheses
(none of which have been proven) concern the amount of virus one initially comes into contact
with, potential immunity from previous infections with similar coronaviruses, age and previous
health history, or the immune response of the person infected. Now, a small study performed
by a group from Chongqing Medical University in Chongqing, China, found that people who
fail to develop COVID-19 symptoms may have a weaker immune response to the virus. They
also found that people’s antibody response to SARS-CoV-2 may diminish rapidly after infection
which may have implications for the interpretation of negative serological results.

The study, which presents a detailed clinical and immunological analysis of 37 asymptomatic
patients is presented in a paper in Nature Medicine titled, “Clinical and immunological
assessment of asymptomatic SARS-CoV-2 infections.”

Ai-Long Huang and colleagues studied 37 asymptomatic individuals from the Wanzhou
District who were diagnosed with RT–PCR-confirmed SARS-CoV-2 infections but without any
relevant clinical symptoms in the preceding 14 days and during hospitalization. The authors
wrote that “the asymptomatic individuals were admitted to the government-designated
Wanzhou People’s Hospital for centralized isolation in accordance with policy.”
Of the 37 asymptomatic patients—identified in a group of 178 people with SARS-CoV-2
infection—22 were female and 15 male, with ages ranging from 8 to 75 years (median age, 41
years).

The authors found that these patients had a significantly longer duration of viral shedding, with
median duration of viral shedding of 19 days, compared with 14 days in a group of 37
symptomatic patients.
Levels of virus-specific IgG antibodies were significantly lower in the asymptomatic group than
in the symptomatic group during the acute phase of infection, when the virus could be detected
in the respiratory tract.

Eight weeks after the patients were discharged from the hospital, antibody levels were
measured. Of asymptomatic individuals, 93.3% and 81.1% had a reduction in IgG and
neutralizing antibody levels, respectively, during the early convalescent phase, as compared to
96.8% and 62.2% of symptomatic patients.

In addition, asymptomatic patients had lower levels of 18 pro- and anti-inflammatory cytokines.
The authors suggest that this indicates that the asymptomatic patients may have had a weaker
immune response to SARS-CoV-2 infection.

The authors also observed that IgG levels began to diminish within 2–3 months of infection in a
large proportion of the asymptomatic patients, which was determined using a magnetic
chemiluminescence enzyme immunoassay test. Indeed, 40% of asymptomatic individuals
became seronegative and 12.9% of the symptomatic group became negative for IgG in the early
convalescent phase. The authors noted that reduction in IgG and neutralizing antibody levels in
the early convalescent phase might have implications for immunity strategy and serological
surveys.

They argue that this finding, along with previous analyses of neutralizing antibodies in patients
recovering from COVID-19, highlights the potential risks of using “immunity passports” and
supports the continuation of public-health interventions and widespread testing. Additional
studies of larger groups of symptomatic and asymptomatic patients are urgently needed to
determine the duration of antibody-based immunity.

Asymptomatic COVID-19 Cases May Have Weaker

Immune Responses (Article 1)
 A SARS-CoV-2 infection can result in a wide spectrum
of symptoms, from asymptomatic to gravely ill.
 Majority of people infected with SARS-CoV-2
experience a mild to severe respiratory illness with
symptoms that include fever, cough, and shortness of
breath—appearing 2–14 days after exposure.
 People who fail to develop COVID-19 symptoms may
have a weaker immune response to the virus.
 People’s antibody response to SARS-CoV-2 may
diminish rapidly after infection which may have
implications for the interpretation of negative
serological results.
 Asymptomatic patients had a significantly longer
duration of viral shedding, with
median duration of viral shedding of 19 days,
compared with 14 days in a group
of 37 symptomatic patients.
● Levels of virus-specific IgG antibodies were
significantly lower in the asymptomatic group than in
the symptomatic group during the acute phase of
infection, when the virus could be detected in the
respiratory tract.
● Asymptomatic patients had lower levels of 18 pro- and
anti-inflammatory cytokines.
● Asymptomatic patients may have had a weaker
immune response to SARS-CoV-2 infection.
 ● Reduction in IgG and neutralizing antibody levels in
the early convalescent phase might have implications
for immunity strategy and serological surveys.

https://www.express.co.uk/news/uk/1301975/Coronavirus-news-latest-covid19-lockdown-social-
distancing-immune-system

Coronavirus: Lockdown and social distancing could

WEAKEN immune system – scientist warns
DRACONIAN lockdown measures and the lack of social interaction could weaken the
human immune system and make us more susceptible to new viruses, a leading scientist
has warned.
Sunetra Gupta, professor of theoretical epidemiology at the University of Oxford, has highlighted
how intense social distancing for a prolonged period of time could mean the human body is less
exposed to ordinary germs and therefore weaken our defences against future diseases. Professor
Gupta hit the headlines in March after her team’s best case scenario model for the impact of COVID-
19 was published.
The project worked on the theory coronavirus hit the UK in December and would spread rapidly
through the population, creating “herd immunity” against COVID-19.
The Government introduced the lockdown on March 23 after a rival project by Professor Neil
Ferguson from Imperial College London, warned the worst-case scenario would result in half a
million COVID-19 deaths in the UK.
Professor Gupta, who has since called for the UK lockdown to be eased far sooner, has compared
the human immune system to trees “waiting to be set ablaze”.

She told The Daily Telegraph: “This is a warning to not assume that the situation where we don’t
suffer regular assaults by pathogens puts us in a better position.
“If we return to the point where we have no exposure, where we keep everything out and return to a
state of existing as relatively isolated communities, we are like clumps of trees waiting to be set
ablaze.“That’s how things were in the age of pandemics.” 
The leading epidemiologist also compared the current living conditions and lack of exposure to
viruses to an extreme example in 1918 and the Spanish Flu - which proceeded after decades of no
diseases and went on to kill 50 million people.

On the severity of the Spanish Flu pandemic, she said: “That was because in 1918 there had been
no flu at all around in Europe for 30 years.
“We weren’t globally connected then as we are now.
"Effectively we used to live in a state largely similar to lockdown 100 years ago, which created the
conditions for the Spanish flu to come and kill 50 million people.”
COVID-19 is a very complex disease and is linked to the deadly SARS outbreak in China in 2003 -
which killed more than 800 people.

On the different types of coronavirus infections, Professor Gupta highlighted the value of being
exposed to similar diseases.
She added: “The kind of immunity that protects you against very severe symptoms and death can be
acquired by exposure to related pathogens rather than the virus itself.”
During the coronavirus pandemic, restrictions on travel have also been a source of controversy -
including the UK’s 14-day self-isolation rules for international arrivals.

Professor Gupta has highlighted the double-edged sword of the global movement of people – she
highlights travelling abroad can enhance the spread of viruses but the mixing with other people in
different environments can strengthen protection against bugs.

She added: “The conditions for the spread of a virus have been enhanced by current practices of
global mixing with worldwide travel.”
“But what also has been strengthened is the level of cross-protection we gain from exposure to
different bugs.”
“Overall, we are in a better place with all this international travel. So, the conditions where a
pathogen might kill a lot of people has been reduced.”
Coronavirus: Lockdown and social distancing could
WEAKEN immune system (Article 2)
 How intense social distancing for a prolonged period
of time could mean the human body is less exposed to
ordinary germs and therefore weaken our defences
against future diseases
 The kind of immunity that protects you against very
severe symptoms and death can be acquired by
exposure to related pathogens rather than the virus
itself
 travelling abroad can enhance the spread of viruses
but the mixing with other people in different
environments can strengthen protection against bugs.
ARTILCLE 4

Since the December outbreak in Wuhan, China, the new coronavirus has spread rapidly, with 7.4 million
confirmed cases in the world as of mid June. According to the Centers for Disease Control and
Prevention (CDC), the virus that causes the disease known as COVID-19 seems to be spreading in the
community in certain affected geographic areas. As with any virus, however, there are simple steps you
can take to protect yourself.

Know the signs

The symptoms of infection for the new coronavirus are often similar to those of other respiratory virus
infections, such as influenza. Symptoms can include fever, cough, or shortness of breath. Most people
will only have mild symptoms, but some can become very sick. When person-to-person spread has
occurred with other novel coronaviruses that caused diseases such as Middle East Respiratory Syndrome
(MERS), it is thought to have happened mainly via respiratory droplets produced when an infected
person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. Spread of
MERS and SARS has generally occurred between people in close contact.

“The means of transmission is similar: through respiratory droplets produced when a person coughs or
sneezes, or by direct physical contact with an infected person, such as shaking hands,” says Dr. David
Goldberg, internist and infectious disease specialist at NewYork-Presbyterian Medical Group
Westchester and an assistant professor of medicine at Columbia University Vagelos College of Physicians
and Surgeons.

If you think you may have been exposed to a person with COVID-19 and have symptoms, before going to
a doctor’s office or emergency room, call ahead and tell them about your symptoms and any recent
travel. You can also utilize a virtual care platform, such as NewYork-Presbyterian’s NYP OnDemand, to
meet with a healthcare professional by video conference. Depending on the severity of your symptoms,
your doctor will determine whether or not you need to come in to be evaluated. Avoid contact with
others and wear a face mask if you need to leave your home when you are sick.

Infographic showing how the new coronavirus spreads.

How contagious is the new coronavirus? A person infected with the new coronavirus can spread the
virus to 1.5 – 3.5 people. This metric, known as the R0 or R-naught, describes how contagious a virus is.
Here, we show how quickly the new coronavirus can jump from 1 infection to over 1 million.

Keep things clean

Preventative measures are your first line of defense. The best way to protect yourself from COVID-19 is
to practice good hygiene and to make these CDC recommendations part of your routine:

Wash your hands often with soap and water for at least 20 seconds, especially after going to the
bathroom; before eating; and after blowing your nose, coughing, or sneezing.
If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60%
alcohol. Always wash hands with soap and water if hands are visibly dirty.
Avoid touching your eyes, nose, and mouth with unwashed hands.
Avoid close contact with people who are sick.
Stay home when you are sick.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash and wash your hands. If you
don’t have a tissue, cough or sneeze into your elbow, rather than into your hands.
Clean and disinfect frequently touched objects and surfaces.
Visit the CDC for guidelines on how to properly wash your hands and use hand sanitizer. (Yes, there’s
plenty of science behind this basic habit.)

Wear a cloth face mask

On April 3, the CDC changed its guidelines on face masks, recommending that people wear cloth face
coverings in public settings. This is especially encouraged in situations where social distancing is difficult
to maintain (such as in a grocery store or pharmacy) and in areas of significant community-based
transmission. According to the CDC, studies have shown that individuals with the novel coronavirus
could be asymptomatic or pre-symptomatic, prompting them to make this new recommendation. While
this measure is intended to help mitigate the spread, it’s important to note that it does not replace
social distancing recommendations. In addition, surgical masks and N-95 respirators should remain
reserved for healthcare workers and medical first responders.

Avoid close contact

The CDC recommends maintaining a distance of approximately 6 feet from others in public places since
respiratory droplets produced by coughing or sneezing do not travel more than 6 feet. While at home,
remind everyone to practice everyday preventive actions – such as washing hands and wiping down
surfaces – to help reduce the risk of getting sick. If you are symptomatic and have tested positive for
COVID-19 but do not require hospitalization, you should stay in a specific “sick room” and away from
other people in your home as much as possible and use a separate bathroom, if available. If your living
space makes it difficult to keep a 6-foot distance, stay as far apart as you can and continue to practice
good hygiene and wear a mask.

Restrict your travel

Many states have put out the call for individuals to stay home, except to make essential trips to the
grocery store, pharmacy or for some outdoor exercise.

The CDC recommends that travelers avoid all nonessential travel to Brazil, China, Iran, most European
countries, the United Kingdom and Ireland. Most foreign nationals who have been in one of these
countries during the previous 14 days will not be allowed to enter the United States. “For people at risk
for the complications of COVID-19, such as those with underlying medical conditions or those who are
older, it’s prudent to avoid any long-distance travel,” says Dr. Goldberg.

Stay up to date with CDC’s travel health notices related to this outbreak.

How NewYork-Presbyterian is prepared

Rest assured, NewYork-Presbyterian is following the situation closely and implementing all
recommendations provided by our local and state departments of health and the CDC. Our medical staff
is trained to recognize patients who may have COVID-19 and to keep the new virus from spreading.

We understand how important the support of loved ones and friends is to patients during their hospital
stay. At the same time, the new coronavirus requires NewYork-Presbyterian to temporarily adjust our
visiting policy in order to keep our patients and visitors safe from infection. Please see our updated
visitor guidelines.
For more information on the evolving situation and how to protect yourself from coronavirus, visit the
CDC and check NewYork-Presbyterian for more updates