Right now that we could enjoy greater freedom from the restrictions imposed so far by the health emergency, infections are starting to rise again and reinfections are worrying. After the data of the Report of the Istituto Superiore di Sanità, social networks are also flooded with testimonies of pluri-infected people. But which are the subjects that are most at risk of reinfection?
The data of the Iss
According to the ISS Report, in the last week the percentage of reinfections out of the total reported cases is equal to 3.2%. “It may seem like a low percentage, but in reality what emerges from the ISS data is that there is a strong increase in reinfections”, he points out. Massimo Andreoni, full professor of infectious diseases at the Tor Vergata Polyclinic in Rome and scientific director of the Italian Society of Infectious and Tropical Diseases (Simit). What does it mean? “It is a testament to the fact that both the vaccine protection and that given by natural immunity, ie from the previous infection, protect less against the Omicron variant”.
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Women and young people most at risk
The report also shows that it is mainly women who are reinfected. According to experts, this is due to their greater presence in schools where intense screening activity is carried out and also to the fact that they often perform the role of caregiver in the family environment. Among the subjects most at risk are also young people: cases of reinfection are more common in the age groups from 12 to 49 years than in people with the first diagnosis between the ages of 50-59. “Probably the greater risk of reinfection in the younger age groups is attributable to higher risk behaviors and exposures, compared to the over 60 age groups”, writes the ISS in its report. The risks are higher than the rest of the population even among health professionals. In total, reports the ISS, from 24 August 2021 to 16 March 2022, 264,634 cases of reinfection were reported, equal to 3% of the total number of cases notified.
The time factor
Reinfection is occurring, in particular, in subjects with the first diagnosis of Covid-19 notified for more than 210 days (i.e. seven months) compared to those who had the first diagnosis of Covid-19 between the previous 90 and 210 days and in subjects unvaccinated or vaccinated with at least one dose over 120 days compared to vaccinated with at least one dose within 120 days. “Certainly – confirms Andreoni – the risk of getting infected is greater depending on the distance compared to the first infection because the more distant you are, the more immunity weakens especially if you have not made the call”. General health conditions also increase the risk of re-infection: “An immunosuppressed patient, that is, who does not have a very effective immune response, is more likely to be infected for the first time and to be reinfected than a subject with a good immune response “, declares the infectious disease specialist.
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The genetic question
But the time factor also comes into play for other aspects concerning the characteristics of the new variants. “In the progression of the variants – explains Andreoni – the phylogenetic distance, that is the genetic difference between one variant and the other, has progressively increased. An infection contracted with the Alpha variant, which is one of the first to circulate, has an enormous genetic difference compared to Omicron and therefore inevitably the immune response is less effective than the new variant “. The genetic component, in reality, should also be studied more to understand why some people are particularly predisposed to infection and others, on the contrary, seem to be super-resistant. “In my clinical experience – continues the scientific director of Simit – I see several people who have already had three infections, on average once a year which makes me think that there are some genetic protective factors and others, instead, of particular susceptibility. , aspects that we have only partially studied so far “.
The ‘original sin’ of vaccines
And who, on the other hand, gets re-infected after getting the vaccine? On social networks there is a tam tam of people who complain precisely that they got sick despite having had three doses of the vaccine. “Surely – explains Andreoni – we pay the price of the fact that all the vaccines in use are based on the Wuhan virus that circulated two years ago in China. It is a bit of their original sin but this applies to all variants and not only. for Omicron. The fact is that the arrival of new variants has slightly changed the effectiveness of the vaccine “. There is no doubt, however, that vaccines confirm their effectiveness in reducing the rate of hospitalization and intensive care admission, as well as mortality. “These data – continues the infectious disease specialist – continue to be strongly encouraging even if when we return to such important levels of circulation of the virus inevitably, even if the vaccine is valid and effective, we have to expect a few more cases of hospitalization above all. considering that there is always a quota of unvaccinated subjects “.
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Reinfections in children
The Omicron variant, still prevalent in Covid infections, runs like measles and is responsible for the increase in cases among children, including reinfections, also because the vaccination rate remains low in the 5-11 age group. “Normally the immune system of children works better than that of adults, therefore, they have the ability to immunize themselves more effectively than an elderly person”, reassures Andreoni. “Having said that, however, children are still at risk of reinfection and some cases have already been registered. The only strategy to be adopted is to vaccinate them in order to protect them from the risk of serious illness which unfortunately also occurs. in children “.
Symptoms and Long Covid in Reinfection
Will those who become infected a second time have fewer symptoms since they have already encountered the disease? “In reality – replies Andreoni – it is by no means certain that reinfection will pass in a paucisymptomatic or calm manner. We have received, for example, some reports in both adults and children with an important course, therefore, it is not to be taken lightly”. And then it remains to understand the question of Long Covid in a person who has been infected several times: “This is a topic on which there is not yet a lot of literature and that needs to be explored. Certainly those who get sick several times undergo a summation of events and it is very likely that the symptoms following the infection are also more annoying and perhaps even more prolonged over time “.
Too soon to return to normal?
With the stop of the state of emergency at the end of March and the masks and the Green pass from May we all began to breathe the air of freedom. In light of the increase in infections and reinfections, is it a mistake bearing in mind that there is always a quota of unvaccinated subjects? “It has always been clear that the less we protect ourselves with the precautions taken during a state of emergency – replies Andreoni – the more we run the risk of encountering the virus and getting sick. can return to normality also in the wake of the reassured messages that have arrived from the institutions, many people have let their guard down and this is precisely the moment in which to resort to the sense of responsibility of the individual “.
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Flexibility and common sense
In short, without wanting to go back and continuing to look forward, once again the management of this virus that has now accustomed us to surprises requires a good dose of common sense. “To say that we will return to the stadium with a 100% presence – points out Andreoni – is a good thing, but it leads people to believe that it is all over and that everyone can behave as they want, but in this moment with such a high circulation of the virus, the probability that in a venue such as a football stadium where 40-60,000 people enter there will be infected subjects is statistically very high “. So what is the right measure to loosen the restrictions without increasing the risks? “We should think of intervention measures that are also very flexible and very rapid. Without going so far as to declare a state of emergency, when the data indicate that the virus is circulating a little more, then precautionary measures can be adopted to be set aside as soon as the epidemiological data they return to normal “, replies the infectious disease specialist of Tor Vergata.