Background: The recent ongoing outbreak of coronavirus disease 2019 (COVID-19), still is an unsolved problem with a growing rate of infected cases and mortality worldwide. The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is targeting the angiotensin-converting enzyme 2 (ACE2) receptor and mostly causes a respiratory illness. Although acquired and resistance immunity is one of the most important aspects of alleviating the trend of the current pandemic; however, there is still a big gap of knowledge regarding the infection process, immunopathogenesis, recovery, and reinfection.
Aim of review: To answer the questions regarding "the potential and probability of reinfection in COVID-19 infected cases" or "the efficiency and duration of SARS-CoV-2 infection-induced immunity against reinfection" we critically evaluated the current reports on SARS-CoV-2 immunity and reinfection with special emphasis on comparative studies using animal models that generalize their finding about protection and reinfection. Also, the contribution of humoral immunity in the process of COVID-19 recovery and the role of ACE2 in virus infectivity and pathogenesis has been discussed. Furthermore, innate and cellular immunity and inflammatory responses in the disease and recovery conditions are reviewed and an overall outline of immunologic aspects of COVID-19 progression and recovery in three different stages are presented. Finally, we categorized the infected cases into four different groups based on the acquired immunity and the potential for reinfection.
Key scientific concepts of review: In this review paper, we proposed a new strategy to predict the potential of reinfection in each identified category. This classification may help to distribute resources more meticulously to determine: who needs to be serologically tested for SARS-CoV-2 neutralizing antibodies, what percentage of the population is immune to the virus, and who needs to be vaccinated.
Keywords: ACE2, Angiotensin-converting enzyme 2; ADE, Antibody-dependent enhancement; ARDS, Acute respiratory distress syndrome; Ang II, Angiotensin II; BAL, Bronchoalveolar lavage; COVID-19; COVID-19, Coronavirus disease 2019; Coronavirus; ERS, Early recovery stage; FcR, Fc receptor; ISGs, Interferon-stimulated genes; Immunity; LRS, Late recovery stage; N, Nucleocapsid; NAb, Neutralizing antibody; NK, Natural killer; PBMCs, Peripheral blood mononuclear cells; PSO, Post symptom onset; RBD, Receptor-binding domain; RT-PCR, Real-time reverse transcriptase–polymerase chain reaction; Recovery; Reinfection; SARS-CoV-2; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; sACE2, Soluble ACE2.
© 2021 The Authors. Published by Elsevier B.V. on behalf of Cairo University.