Hypothesis to explain the severe form of COVID-19 in Northern Italy

1. Luca Cegolon1,2,
2. Jennifer Pichierri3,
3. Giuseppe Mastrangelo4,
4. Sandro Cinquetti1,
5. Giovanni Sotgiu5,
6. Saverio Bellizzi6,
7. Giuseppe Pichierri7

Author affiliations

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http://dx.doi.org/10.1136/bmjgh-2020-002564

Summary box

What is already known about this subject?

• Human coronaviruses are known to cause respiratory re-infections, regardless of pre-existing humoural immunity.
• There is evidence suggesting that severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) had been circulating in Italy before the first COVID-19 case was detected in the country.

What are the new findings?

• Prior infections with SARS-CoV-2 (or other viruses/coronaviruses) may arguably predispose to more severe forms of the disease following re-infection with SARS-CoV-2, with an immunological mechanism known as Antibody-Dependent-Enhancement, already observed with infections sustained by other coronaviruses (MERS-CoV and SARS-CoV) or other viruses such as the West Nile Virus and Dengue.

What are the recommendations for policy and practice?

• If confirmed by in vivo studies, this hypothesis may have relevant implications for the treatment of severe forms of COVID-19, yet the possibility to produce an effective vaccine against SARS-CoV-2 might be hampered.

https://gh.bmj.com/content/5/6/e002564