The (apparent) antibody paradox in COVID-19

Abstract

Introduction The immunological response to COVID-19 is only partly understood. It is increasingly clear that the virus triggers an inappropriate host inflammatory reaction in patients experiencing severe disease. Areas covered The role of antibodies in COVID-19 remains to be fully defined. There is evidence for both protection and harm in different clinical syndromes triggered by SARS-CoV-2. Many patients dying from COVID-19 had both high titers of antibodies to SARS-CoV-2 and elevated viral loads. The uncertain protective role of humoral immunity is mirrored by the lack of benefit of therapeutic convalescent plasma infusions in COVID-19. In contrast, there is increasing evidence that a vigorous T-cell response is protective. Delayed or low avidity T cell reactions were seen in patients suffering severe COVID-19. Expert opinion These observations suggest T cell responses to SARS-CoV-2 are the dominant long-term protective mechanism following either infection or vaccination. The magnitude and quality of the antibody response is likely to reflect underlying T cell immunity to SARS-CoV-2. Much of what has been learned about COVID-19 will need to be revised following the recent rapid emergence and dominance of the omicron variant of SARS-CoV-2.

SARS-CoV-2 Omicron: Light at the End of the Long Pandemic Tunnel or Another False Dawn for Immunodeficient Patients?

“…The role of antibodies in the outcome of COVID-19 is uncertain. 18 There is evidence for both protection and aggravation of disease by antibodies. 18 In severe cases, there is a risk of antibody disease enhancement.…”

The Nature of the Problem of Immunity and its Solution

“…1 I believe that the love for Science, which requires all our statements to be in complete agreement with facts, must necessarily lead you to the view that such an accurate description is demanded by the fact that the response in which the phagocytosing cells of Mechnikov and other white blood cells are brought into the tissues from the blood is the very same response that harms the organism 2, which ought to be protected if indeed white blood cells, which include those that kill cells directly as well as those that destroy them with antibodies, are indeed immune cells. And I also believe that the same love will lead you to the view that observations such as high levels of antibodies to the coronavirus known as SARS-CoV-2 in many patients dying from COVID-19 3 require this demand to be urgently met for the goal of preventing such unfortunate losses of our own in this pandemic and others which, if such a requirement is not met before they appear, may even be as deadly as an Ebola pandemic or a pandemic of malignancies such as the one that decimated Tasmanian devil populations.…”

What Predicts the Victims of the Severe Pathological Manifestations in Infections?

“…Upon comparing this consequence with the data of experience, what we find is correspondence with the fact that the observation that many patients dying from COVID-19 had both high viral loads as well as high antibody titers which should have been accompanied by reduced viral loads through which the logically deduced defence theory of immunity expects disease severity to be reduced and such outcomes which were seen in such dying patients to be averted. 21 And the conclusion which was reached when such observations were made is that antibody responses did not necessarily confer protection 21 as expected by this deduced theory.…”

“…It has been logically deduced that the ultimate COVID-19 death toll will be determined by the outcome of this race between global vaccination and emergence of escape mutants. 21 But in reality we have illustrated, the death toll will be determined by our ability to ensure that the vaccinated and the treated are sufficiently exposed to conditions that permit immunological mechanisms to obstruct the pathway through which pathological mechanisms respond to SARS-CoV-2 and the causes of the different diseases in the COVID-19 spectrum so that the vaccinated will be asymptomatically exposed to these different causes and remission will occur in the treated in spite of high antibody titers that predict severe COVID-19 outcomes when such conditions disappear rather than the reduction of viral load through which the defence theory of immunity expects us to be protected from such outcomes.…”