In Italy, Going Again to Work Might Depend upon Having the Proper Antibodies

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ROME – In Italy there is a growing feeling that the worst may have passed. The weeks of blocking the country, the center of the deadliest coronavirus outbreak in the world, could gradually pay off, as officials announced this week that the number of new infections is on a plateau.

This glimmer of hope has brought about a change in conversation about the enormous challenge of when and how to open again without triggering another catastrophic wave of contagion. To this end, Italian health officials and some politicians have focused on an idea that could once have been relegated to the field of dystopian novels and science fiction films.

Having the right antibodies to the virus in the blood – a potential marker of immunity – could soon determine who gets to work and who doesn't, who is locked up, and who is free.

This debate is somewhat ahead of science. The researchers are not sure whether antibodies actually indicate immunity. However, this has not stopped politicians from grasping the idea as they are under increasing pressure to open economies and avoid widespread economic depression.

The conservative president of the northeastern Veneto region has proposed a special “license” for Italians who have antibodies that show they have had the virus and have struck. Former Prime Minister Matteo Renzi, a liberal, has spoken of a “Covid Pass” for the uninfected. Prime Minister Giuseppe Conte said that while the ban remained in place, the government had started working with scientists to find out how to get people who had recovered back to work.

With the echo of a “brave new world” The debate about the reopening took place this week in Italy. Like the death rate of the virus – around 14,681 deaths in Italy on Friday evening – the shift lies ahead of countries such as Spain, Great Britain and the United States, where the contagion is still on the up.

Italy was the first country European country announces a nationwide ban that began on March 9th. However, the rate of new infections slowed this week – there were about 4,500 new cases on Friday, fewer than in recent weeks – with which senior officials and first responders alike spoke cautiously optimistic.

"We are beginning to see the light at the end of the tunnel," said Fabio Arrighini, head of an ambulance hotline in the Lombard city of Brescia, which has one of the highest mortality rates in Italy. "The calls have dropped."

But the debate over an antibody-based workforce has once again brought Italy to the unfortunate avant-garde of Western democracies who are concerned with the virus, its unpleasant ethical decisions, and its inevitable consequences. Such questions have already been raised by doctors' difficult decisions to treat young people with a better chance of life than the old and sick.

But at some point, almost all governments will have to strike a balance between ensuring public security and regaining their countries. They may also find that they weigh the best for society against the rights of individuals, using biological criteria that would almost certainly be rejected without the current emergency.

"It looks like humanity is divided into two parts, the strong and the strong the weak," said Michela Marzano, professor of moral philosophy at the Descartes University in Paris. "But that's actually the case."

From an ethical point of view, she argued, the question of using antibodies as the basis for free movement reconciles a utilitarian vision of what is best for society with respect for individual humanity. by protecting "the most fragile, not marginalizing".

"It is not discriminatory," she said. "It protects."

Scientists in Italy, like their colleagues in Germany, the United States, China and beyond, are already investigating whether antibodies are a potential source of protection or immunity to the virus.

China has slowly reopened its economy and focused on preventing another wave of infection from overseas. In New York, Governor Andrew M. Cuomo envisioned a strategy that could help younger people and people with antibodies to prove that they had been cured of the virus work again.

The UK government is in circulation with the idea of ​​"immunity passports", although it is still difficult to do swab tests yourself to get an accurate snapshot of current infection rates and the virus has not been around in the UK population long enough was available to provide sufficient antibody data.

Due to its early and widespread exposure to the virus, Italy has the opportunity to gain insight into how the virus works and the biological properties that protect it.

Next week, Veneto plans to collect 100,000 blood samples from people in the region – first from thousands of healthcare workers and then from civil servants – to test the antibodies of people with the virus and theirs in laboratories who are cured of examining.

No. In Italy, the pursuit of the antibody strategy is more intensive than in Veneto. With its wealth of resources, top-class consultants and its presence in biotechnology, it may now be uniquely positioned to influence global conversation and provide insights to the rest of the world.

The region is next to the most affected regions The Lombardy region and one of its cities, Vo & # 39;, had Italy's first death from the virus and were one of the first cities in the country to be quarantined were.

Vo & # 39; also has a relatively homogeneous genetic pool that can facilitate research and has been extensively tested. After the outbreak, officials there took the extraordinary step of dabbing the entire population of 3,000 people, including those without symptoms.

This helped clear an outbreak, and officials are now planning to do antibody testing and genome sequencing. The entire population could see patterns of who was and who was not susceptible to the virus.

These results, which were expected in three or four months, could possibly explain why some remained asymptomatic while others got sick, whether those who were not infected already had antibodies and whether children had anything that helped them avoid disease.

“Of course, Italy currently has one of the largest pools of infected people who have recovered from the infection. Said Andrea Crisanti, the leading scientific advisor for the virus in Veneto and professor of microbiology at the University of Padua. He added that it was "a unique and valuable collection of information and data".

Dr. Crisanti stressed the need for a carefully crafted strategy to develop Italy that uses contact tracking, protective equipment and aggressive testing of post-virus antibodies.

"The upcoming planning is one of the most important things." Dr. Crisanti said. "Because it's easy to lock." Without an appropriate strategy for the way forward, "the most likely outcome is that the epidemic will start again."

Scientists in Italy said that the virus produces two types of antibodies, a first one that normally occurs within five to occurs six days after exposure to the virus, and which fades after 20 days. When a person heals, this antibody, which indirectly shows contagion, is slowly replaced by another antibody, which indirectly shows that a person has the virus.

If only the second antibody is detected, it means that it is probably a person who is no longer infected.

"You are most likely a healthy person who either survived the infection or was asymptomatic and developed antibodies," said Dr. Crisanti.

In Veneto, regional president Luca Zaia expressed concern about a single case of "a person who got better and was reinfected", but he and his advisors appear to be confident about the potential of antibodies.

The antibodies in healed Italians could Dr. Crisanti said this was a valuable tool in determining who could safely exit quarantine to work. The key to unlocking it would be to limit the likelihood of infection and transmission, he said, since the strength of the virus itself remained constant.

He argued that the small town of Vo ideal conditions for antibodies and genome testing.

"The good thing about Vo & # 39; is that this is a community that has existed for hundreds of years and is likely to be very little mixed," he said, giving a clearer genetic picture.

Giuliano Martini, Mayor of Vo & # 39; said he and the people in his city were grateful for the aggressive tests that could potentially save hundreds of lives.

When the central government in Rome was lifted. According to Martini, the first quarantine for Vo & # 39; in early March, the extensive tests identified people who were infected but asymptomatic and prevented the spread of the disease.

Making the city available to researchers Trying to learn more about the virus and its antibodies is "the least we can do," he said.

"We have to acknowledge this effort by making ourselves available for future testing," he said. The city is still a gold standard for active surveillance in Italy and "we know the first and last name" of all those remaining in quarantine.

For residents who do not want to take part in the new study He admitted that it was more intrusive as it was a blood test. "We go to their home and convince them."

"There will be no problem for this second test," he said. "It is an additional control over them, it can be nothing more than positive. "

But the results may not be good news for people who may be excluded from society by law.

In Veneto, Mr. Zaia has suggested that Italians who have antibodies who show that they no longer have the virus could receive a “license” that enables them to move and work in the country.

Dr. Luisa Bracci Laudiero, immunologist at the Italian National Research Council said that the antibodies "should protect, we all hope they are, but we don't have the mathematical certainty." She said the researchers were in China, the Italy that preceded the outbreak g, searched for evidence of immunity.

But Italy was also more advanced in research than the rest of the West.

"Here the disease has been in full development for a month and a half," she said, adding that the researchers have been able to track so many patients over a long period of time to determine if immunity has developed.

"We We are a bit of a laboratory," she said.

Emma Bubola contributed to reporting from Verona.

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