Esperanza para salvar vidas y reactivar la economía: el estudio que confirma la inmunidad de quienes tuvieron COVID-19

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Científicos de la Escuela de Medicina Icahn en el hospital Mount Sinai de Nueva York analizaron la sangre de 1.343 personas que se habían infectado con el nuevo coronavirus. Casi la totalidad creó anticuerpos

12 de Mayo de 2020

Todo indica que el nuevo Coronavirus  seguirá siendo una amenaza, contra la cual aún no hay tratamiento infalible ni vacuna. Por eso es central saber si los anticuerpos que logra desarrollar una persona que se infecta y se recupera se mantienen en su sistema: eso permitiría una reapertura de la sociedad global, golpeada por la pandemiamedianamente segura, ya que los curados no podrían sufrir una segunda infección.

En los últimos días se ha hablado mucho de las pruebas de anticuerpos para determinar quién es inmune y podría regresar al trabajo: por ejemplo, Alemania, el Reino Unido y Chile han planteado la idea de unos documentos o “pasaportes de inmunidad ” que permitirían que aquellos que no pueden volver a contagiarse reemplacen a las personas vulnerables, en particular en lugares que presenten mayores peligros de transmisión, como los hospitales o el transporte público.

Un nuevo estudio preliminar trajo un poco de esperanza en esta dirección, que los expertos llaman “inmunidad escudo”: estableció que casi la totalidad de la personas que sufrieron de COVID-19 , más allá de su edad, su sexo o la gravedad de la enfermedad, crearon anticuerpos para el virus. Los autores, de la Escuela de Medicina Icahn en el hospital Mount Sinai de Nueva York, establecieron que “más del 99% de los pacientes que informaron haber tenido una infección de SARS-CoV-2 o la documentaron con pruebas, desarrollaron anticuerpos”, según identificaron con una variedad de métodos en 1.343 pacientes.

Los estudios tomaron en cuenta la inmunoglobulina M, la primera defensa del organismo, y la Inmunoglobulina G, que permanece en la memoria del cuerpo. (REUTERS/Adrees Latif)

Los estudios tomaron en cuenta la inmunoglobulina M, la primera defensa del organismo, y la Inmunoglobulina G, que permanece en la memoria del cuerpo. (REUTERS/Adrees Latif)

Entre ellos, además de la prueba de anticuerpos tradicional, que da muchos falsos positivos —es decir, que identifica señales de anticuerpos cuando no las hay—, se destacó un test desarrollado por Florian Krammer, virólogo de Icahn, que tiene menos de 1% de falsos positivos.

“Además, nuestros hallazgos sugieren que los anticuerpos de inmunoglobulina G [una de las cinco clases de anticuerpos que produce el organismo, que predomina en los líquidos corporales como la sangre] se desarrollan en un periodo de 7 a 50 días desde el comienzo de los síntomas y de 5 a 49 días desde el fin de los síntomas, con un promedio de 24 días desde el comienzo de los síntomas hasta la mayor concentración de anticuerpos y un promedio de 15 días desde el fin de los síntomas hasta la mayor concentración de anticuerpos”, escribieron.

El análisis dio resultados similares a o otro trabajo realizado sobre 285 pacientes en el Hospital de las Tres Gargantas de la Universidad de Chongqing, China, que el director del Instituto Nacional de Salud (NIH) de los Estados Unidos, Francis Collins, citó en su blog: “Hallaron que todos habían desarrollado anticuerpos específicos contra el SARS-CoV-2 entre dos y tres semanas de los primeros síntomas”.

El nuevo estudio se realizó en Nueva York, donde el 20% de la población de la ciudad resultó infectada, con o sin síntomas. (REUTERS/Brendan McDermid)

El nuevo estudio se realizó en Nueva York, donde el 20% de la población de la ciudad resultó infectada, con o sin síntomas. (REUTERS/Brendan McDermid)

Esta investigación se centró en más tipos de anticuerpos, como la inmunoglobulina M, que es “el primero que el cuerpo produce cuando combate una infección”, explicó Collins. “Aunque sólo un 40% [de los 285 infectados con el coronavirus del estudio] produjeron inmunoglobulina M en la primera semana luego del inicio del COVID-19, esa cifra aumentó de manera constante hasta casi el 95% dos semanas después“, precisó. “Todos estos pacientes también produjeron un tipo de anticuerpo llamado inmunoglobulina G, que si bien aparece un poco más tarde luego de una infección aguda, tiene el potencial de conferir una inmunidad sostenida”.

Uno de los puntos más importantes de la investigación de Mount Sinai —la que más pacientes analizó, hasta ahora, sobre la cuestión de los anticuerpos— es que mostró que no sólo aquellos que estuvieron gravemente enfermos crearon anticuerpos: todos lo hicieron, también los que sólo tuvieron los síntomas de un resfrío. Del mismo modo, otros factores como la edad o el sexo no afectaron la producción de anticuerpos: básicamente cualquiera que se infectó con SARS-CoV-2 los desarrolló.

Los científicos —bajo la dirección de Ania Wajnberg— trabajaron sobre un grupo de donantes de plasma convaleciente. Sólo el 3% de ellos había necesitado ir a una sala de emergencias o ser hospitalizado. Los demás sólo tuvieron síntomas moderados. “Hasta donde yo sé, este es el grupo más grande de gente que describió una enfermedad suave”, dijo Wajnberg a 

No sólo aquellos que estuvieron gravemente enfermos crearon anticuerpos: todos lo hicieron, también los que sólo tuvieron los síntomas de un resfrío. (REUTERS/Rupak De Chowdhuri)

The New York Times.No sólo aquellos que estuvieron gravemente enfermos crearon anticuerpos: todos lo hicieron, también los que sólo tuvieron los síntomas de un resfrío. (REUTERS/Rupak De Chowdhuri)

En detalle, el equipo estudió muestras de 624 personas que habían dado positivo en una prueba de COVID-19 y se habían recuperado. Al comienzo solo 511 de ellos tenía altos niveles de anticuerpos, 42 tenían bajos y 71 no tenían. Pero cuando 64 de los donantes que habían tenido niveles bajos o ausentes se sometieron a un segundo análisis, todos excepto tres mostraron anticuerpos.

Eso significa que muchos de los resultados negativos que actualmente se ven pueden ser consecuencia del momento en que se los hace: “Si bien no buscábamos esto, encontramos lo suficiente como para decir que 14 días es probablemente demasiado pronto”, dijo Wajnberg. “Actualmente le estamos diciendo a la gente que [el momento óptimo para el test de anticuerpos] es al menos tres semanas después de la aparición de los síntomas”.

Otro descubrimiento lateral pero valioso del estudio fue que los tests que buscan directamente el coronavirus, cuya imagen más común es el hisopado, pueden dar positivo aun cuando un paciente parece curado, hasta 28 días después del comienzo de la infección. Eso explicaría por qué una persona, aun cuando dio negativo en la prueba, podría volver a dar positivo sin que eso significara que contrajo una segunda infección.

De manera adicional, la investigación explicó por qué hay falsos positivos en los hisopados en personas que ya se recuperaron: los fragmentos de ARN pueden existir en una célula aun cuando el virus esté inactivo. (REUTERS/Brendan McDermid)

De manera adicional, la investigación explicó por qué hay falsos positivos en los hisopados en personas que ya se recuperaron: los fragmentos de ARN pueden existir en una célula aun cuando el virus esté inactivo. (REUTERS/Brendan McDermid)

Ya el Centro para el Control y la Prevención de las Enfermedades de Corea del Sur habían argumentado que los 292 casos de esa índole que habían tenido en el país se debían a componentes muertos del virus que permanecieron en las células de los pacientes. Oh Myoung-don, titular del comité que postuló esa hipótesis, dijo a la agencia de noticias oficial, Yonhap, según Newsweek: “Los fragmentos de ARN [el material genético de los virus] pueden existir en una célula aun cuando el virus esté inactivo”. Además, por el modo en que el SARS-CoV-2 interactúa con el ADN humano, no tiene capacidad para “crear infecciones crónicas”, subrayó.

No es novedoso: algo similar sucede con el virus del sarampión, que se puede detectar seis meses después de la enfermedad, dijo Krammer al Times; los del ébola y el zika permanecen aún más tiempo en el cuerpo.

El trabajo de Mount Sinai confirmó que un alto porcentaje de las personas que mostró anticuerpos nunca había sido diagnosticada con el coronavirus. Es decir que el COVID-19 se expande también entre los asintomáticos. En algunos lugares de mucha densidad de población, como la ciudad de Nueva York, eso implicó una tasa de infección del 20%, según las autoridades estatales. No obstante, advirtió Wajnberg, “la gente no debería suponer que si tuvo fiebre en enero tuvo COVID y ahora es inmune”: entre la muestra de personas que no habían sido sometidas a una prueba, el 62% no tenía anticuerpos, y sus síntomas se debieron a otras enfermedades del tracto respiratorio.

El trabajo de los EEUU confirmó los resultados de otro realizado en China. (REUTERS/Thomas Peter)

El trabajo de los EEUU confirmó los resultados de otro realizado en China. (REUTERS/Thomas Peter)

En una investigación anterior de Krammer, su equipo valoró hasta qué punto los anticuerpos contra el nuevo coronavirus tienen el poder de neutralizar la infección, y encontró que según las mediciones en sangre, el cuerpo humano logra el nivel de actividad neutralizadora. Queda pendiente una pregunta que, por ahora, solo el tiempo responderá: cuánto dura. Algunos creen que un año; otros opinan que en el caso de esta familia de virus puede ser más breve.

“Podrían existir maneras de incorporar pruebas de la inmunidad en el cuadro general de salud de una persona que se puedan utilizar para orientar las precauciones que se deberían tomar en el empleo y en la vida personal”, escribió Scott Gottlieb, ex comisionado de la FDA, en The Wall Street Journal. “A medida que los estados empiezan a relajar las restricciones a la actividad económica y social, los resultados de los tests de anticuerpos pueden ser útiles para evaluar el riesgo de ciertas actividades”, reconoció la importancia del impacto del núcleo de este estudio, la inmunidad.

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