It is not that Covid is better with children, it is children who know how to defend themselves better against the virus, and in fact they are rarely symptomatic and very rarely get sick with serious forms, less than 2% of hospitalizations for COVID-19 are in fact those under the age of 18, according to Italian estimates.
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For some researchers interviewed by Nature so-called innate immunity may have played a key role in protecting children from Covid, that is, that defensive system that we all have from birth and that is particularly powerful in children. Innate immunity, although it is not able to selectively attack pathogens because it does not use immunological memory (the phenomenon by which when we come in contact with a virus or a bacterium we keep track of it and if we meet it again we already have the specific antibodies ready to attack it), but it has the advantage of being fast, rapid. But according to the experts heard from Nature as the pandemic progresses, the spread of the Delta variant and the increase in the number of infections, especially in the pediatric range, this immunity could lose its effectiveness in the long term.
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The revenge of the poor relative
“Innate immunity has always been considered the poor relative of immunity, being a first-line defense mechanism, which intercepts everything, but in a somewhat coarse way waiting for the adaptive immune defense to develop, that is to say that made up of antibodies, super-selective weapons, very targeted and built on immunological memory, “he explains Andrea Campana, head of the Covid center of the Bambino Gesù hospital in Rome.
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“Innate immunity uses many cells – continues the expert – For example, monocytes or natural-killer cells that destroy foreign elements, macrophages that act as if they were scavengers, innate lymphoid cells, which are very powerful weapons. And also epithelial cells, which act as a defense barrier to the outside. Epithelial cells have cytokines, interleukins and other molecules inside them that we can imagine as very powerful bullets that are immediately fired at all foreign elements arriving from the outside. .
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Some studies have shown that the epithelial cells that line the respiratory system could have different receptors that allow children to have a reduced entrance compared to adults of the Covid virus – explains Campana – in addition, evidence in favor of the fact that immunity innate plays a role in the protection against Covid is that we have seen that children with adaptive immunity deficiency, the most sophisticated one, did not get sicker than Covid: another fact that justifies the hypothesis of an important role of innate immunity in the mechanisms of protection against Covid disease “.
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The other hypotheses in the field
Over the past months on the reasons that can explain the greater protection of children from Covid, several hypotheses have in fact been made. One of these has to do with ACE2, the receptor that guides the entry of the virus into human cells and is under-expressed in the respiratory system of children (there is less). “Several publications have already downsized the role of this surface antigen – continues Campana – A reduced presence of ACE2 can reduce the entry into the cells of the virus, but once Sars-Cov-2 has entered, it is the immune system that rules “.
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According to another hypothesis, children, being always exposed to the viruses of the common cold, they would be more able to keep this new virus at bay: “it is as if they had a more alert immune system, particularly stimulated and ready to use – he explains Campana – because of the numerous contacts they have and thanks to the typical childhood vaccines they do. But even this hypothesis alone is not enough. In reality, there is no single answer to the question today why children get sick much less often than Covid. But all the hypotheses must probably be interpreted as contributing factors, as elements that play together, and among these elements there could certainly be innate immunity “.
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“The Delta variant did not change Covid disease in children, but since it is much more contagious than the previous version of the virus and since children are not vaccinated while others are, it circulates a lot in the pediatric range. But circulating so much, even if without causing symptoms, the risk increases that sooner or later a more aggressive variant will emerge among children, also from the point of view of the disease and not only from that of contagiousness. Now, if we understand how the little ones defend themselves from the disease caused from this virus, we can find new strategies to protect them “, explains the expert.
For instance? “If we discover that protection depends on the action of a particular interleukin or an inflammatory cytokine, which as we have seen are hyper-enhanced in children with multi-systemic inflammatory syndrome (mis-c), we could on the one hand prevent mis- c using drugs that neutralize the guilty cytokines, and on the other hand enhance other good cytokines that prevent disease progression. Understanding how things are in children allows us to find new therapeutic weapons because we will have to deal with this virus for a long time.
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Until the whole world is vaccinated, Sars-Cov-2 will continue to mutate and other variants will appear, perhaps no longer pandemic but endemic. We will probably have to do as for other viruses, those for which vaccinations are made every season, but there will always be someone who will not be able to vaccinate, due to pathological conditions, or too young children for whom vaccination is not yet authorized. It is important – concludes Campana – have other therapeutic weapons, in addition to the main one which is vaccination, for children and for everyone “.
The case
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