Development
of the vaccine

As much as institutions need to advertise a return to sudden and reassuring normalcy, the reality of post Covid 19 may not be simple at all. A vaccine will not be ready before a year (in the most optimistic perspective, and this implies at least another winter in the presence of the virus) and even if it is effective, clinically tested and free of side effects, there will still be a part of the population that does not will agree to have it inoculated. Whether they do good or bad is not yet known. But concepts such as immunity and security, necessary elements for a complete return to a progressive normalcy, are and will be for a long time completely fluid, therefore still being defined. At the time of writing (March 2020) the situation looks like this.

There is no form of immediate and safe detection of immunity and there is no scientifically validated system to prove whether or not to be positive in the long term.

The swabs – oropharyngeal sampling systems of the disease, technically PCR Real Time – certify the presence “at this instant” of the virus. This swabs are  not in the least able to define in detail whether the virus:

1. has been contracted but resolved (full immunity)
2. if you are in the initial incubation phase

A negative swab, therefore, does not guarantee the possibility of developing other outbreaks in the future, because it only photographs the present moment and the current condition of the individual patient. It can therefore be certified that the patient is well now, not how he will be in the next few days or weeks. Provided that there are no false positives in the assessments: a far from remote hypothesis, apparently.

In the same way, serological tests can detect in the blood some antibodies related to the Corona virus family (which are very many, with different characteristics and range from normal flu to SARS). However, these do not yet know with absolute precision whether those antibodies represent the immune response precisely to Covid 19.

This means that a person who has contracted a normal Coronavirus related flu – therefore with a decidedly milder course – may have some antibodies related to that family, thus being “immune” to the test. In fact, it could still be completely defenseless in the face of Covid 19 and the consequences of the infection.

As if this were not enough, also in this case there are many occasions when serological tests can develop false positives. Due to the similarity between the various Corona viruses, the detection systems are still not able to verify this difference with 100% safety. A normal influence, therefore, could generate the illusion of an immunity that would not then be present.

At the moment, by crossing the characteristics of both tests, the only systems to “certify” (let’s say so) the immunity to Covid 19 is to:

• have two / three negative swabs several days apart
• test positive for the presence of antibodies in serological tests
• feel good in the long run

Relapses

This was not enough: in fact, the unknown factor of recidivism remains. It is not yet clear whether an already ill patient can develop the disease again due to virus mutations or a new exposure to contaminants. As with normal flu, of which we are ill several times both in different years and in the same year, it is not excluded that recurrence may occur in the short or long distance. The scenario that hypothesizes new contagion capacities, in the case of virus mutation, is still under discussion and will be for a long time.

The big pharmaceutical corporations are carrying out a tight search to patent a system that allows to detect only the antibodies related to Covid 19.

A fast system (today it takes many hours or several days to get the result of a swab), which is scientifically validated (the real deriving element) and 100% safe, at the moment simply does not exist.

We are not interested in discussing this problem from a purely medical point of view. But we need to reflect on the consequences of this scenario. Even if this element would already be sufficient to decree the impossibility of returning to a form of social normality in the short term. A normality, in short, comparable to that experienced only a few months ago.

The prospect, therefore, seems to be that of a first, substantial relaxation of restrictions around May / June 2020. Following a period of variable length (estimated in 2-4 months) where we will try to re-establish a relative order and monetize the obvious revenues deriving from tourism in the summer period, as far as possible. From August / September probably we will see a new, powerful contagion curve grow: then it will be necessary to rethink a new lockdown, perhaps limited in time and optimized in strategies, also in the wake of the errors previously made.

The aim will be to avoid a chronicisation of imprisonment as a way of life and a balanced return to work. Allowing to buy a new, calming, routine, the lack of which (together with the closure in covered spaces, outside of nature) has produced psycho-emotional effects that are still difficult to measure.

And above all, the new measures will aim to limit the danger of new outbreaks in the winter. When the low temperatures, the predisposition to meet in closed places and the need to guarantee continuity to the economic system will push the Nations to slow down so as not to stop completely once again.