Viewpoint SARS-CoV-2 Biology Suggests We Should Protect Our Young Population: state-of-the-art review (Preprint)

BACKGROUND Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was initially known as a virus causing flu-like symptoms, or sometimes pneumonia. Thus, when the World Health Organization (WHO) declared COVID-19 pandemic and suggested lockdown measures, the apparently disproportionate measures were viewed as an inconsistency, raising the question whether measures were exaggerated or the virus was more dangerous than it had been publicly stated. OBJECTIVE The initial objective was to resolve or understand that inconsistency. METHODS As every day counts during an emergency, and there were so many unanswered questions, not only scientific papers but also pre-prints, institutional webpages, newspapers, cruise registers, projects and patents were critically used as information sources and are identified as such. The biology of SARS-CoV-2 was compared to that of SARS and other coronaviruses in order to gain insights. RESULTS COVID-19 is a systemic disease. There is at least one detection report of SARS-CoV-2 in human samples of blood, stool, urine, cerebrospinal fluid, and sperm. Like HIV, SARS-CoV-2 can damage the immune system directly. Like other coronaviruses, SARS-CoV-2 can infect the brain and might contribute to neurodegeneration. Growing evidence indicates that SARS-CoV-2 can establish a persistent infection, with alternating waves of convalescence and recurrence. In addition, even rare latency with ulterior reactivation has not been discarded. SARS-CoV-2 exploits antibody-dependent enhancement (ADE), like Dengue and SARS-CoV. For this reason, it is unlikely that a successful vaccine will be developed. However, there are promising therapeutic alternatives. Host cell targets could be modulated to hamper viral replication, but targeting viral proteins directly would be a better therapeutic design, since fewer adverse side effects would be expected. CONCLUSIONS SARS-CoV-2 name turned out to be inadequate, since this virus is systemic and can persist, affecting most body systems including the immune and the nervous system. This virus is very likely to have long-term effects. According to our current knowledge state (and gaps),infected asymptomatic people should be considered not just as a carrier of a virus that affects the elderly or immune-compromised individuals, but as potential hosts and victims of a persistent/long-term systemic infection. For this reason, we should encourage protection measures towards the young population before it is too late. As lockdown is not a life option, more measures to minimize viral spreading could be adopted, particularly regarding babies, children, adolescents and young adults. There fortunately are promising therapeutic strategies to be developed.