29. WHAT WE DO NOT KNOW: Ramos and Piqué

Is there a genetic or geographic predisposition to COVID-19 complications?

There are more complications with age, especially 70 and over, and mortality is slightly higher in men than in women. It is suspected that there may be a genetic predisposition to have complications from COVID-19, and studies are already underway to identify gene variants that influence the course of the disease. Globally, Africa is one of the least affected regions and the reason is still enigmatic. Could it be the weather? Could it be genetics? How much is the youth of the population a factor?

Saudi Arabia, with an average temperature of 40 degrees, currently has more than 90,000 COVID-19 infections. Maybe closed air-conditioned sites lead to greater spread?

I was wondering if in Islamic countries, where women wear headscarves —which could double as a mask— the percentage of COVID-19 cases has been lower in women than in men. I have looked at a United Nations website, and the answer is that it seems to be yes. While in most countries the percentage of women infected, compared to men, is 50-60%, in Muslim countries such as the Maldives or Pakistan, the percentage of infections in women is 14% and 26% respectively. I have not found data from Saudi Arabia.

Iran is one of the countries most affected by COVID-19, with some 170,000 cases and more than 8,000 deaths. In Iran, compared to other Islamic countries, women are somewhat more liberated from having to wear a covered face. There, the percentage of infected women is 43%. Iran has had a Women’s Soccer League since 2007, although it was a small scandal that put Iranian women’s soccer on everyone’s lips in 2015. In that year, a certain Mojtabi Sharifi, with some position in Iranian football, stated that some players of the Iran Women’s National Team were men. He explained that, although they had decided to be women, at least eight had not yet undergone surgery. And, of course, there were many complaints from the rival teams because, according to FIFA rules, in a women’s football match there’s usually one ball to spot.

Why does COVID-19 sometimes get complicated, causing an overreaction of the immune system, inflammation and clots?

These complications arise in 5% of cases 36. Patient samples are being investigated to find blood markers of disease progression so that blood tests can predict, understand, and treat complications. Even so, Jair Bolsonaro, the president of Brazil, went so far as to say that the virus was a gripezinha ou resfriadinho (meaning tiny influenza or cold). Those musical diminutives remind us of the espaldinhas, or back controls, of Ronaldinho.

Immunity: Who has it? How long does it last?

We know that immunity to the flu lasts a season or two. However, in cases like measles or chicken pox, immunity lasts a lifetime. Once you have it, you don’t have it again. There is no defender in football that can play for a lifetime, although Javier Zanetti came closer than most; with 1,115 professional appearances. What immunity do we have/will we have for SARS-CoV-2 and how long will it last?

We have an innate immune system and an adaptive one. For COVID-19, the focus has been primarily on the adaptive one, whereby B lymphocytes generate antibodies. However, recent studies are beginning to focus on the innate.

Among individuals of the same age, some are more susceptible to the disease than others. The hypothesis that some people are protected by cross immunity, that is, by immunity caused by other similar viruses, is being consolidated. The common cold appears from coronavirus infections to bear some resemblance to SARS-CoV-2. A recent article in the journal Cell suggests that common cold coronaviruses may leave memory in T cells (or T lymphocytes) —of the innate immune system— to attack cells infected by the virus 37. In this way, some people would have an activated first line of defence with the innate immune system and could defend themselves against infection without the need to produce antibodies. What level of infection can be counteracted by T lymphocytes (innate immune system), without the need to use B lymphocytes to make antibodies (adaptive immune system)? It’s not yet known.

On the other hand, thanks to the adaptive immune system, there are people who have generated long-term immunity in the form of antibodies that directly neutralize the virus. In Spain it is estimated that 5% of the population has antibodies against SARS-CoV-2 (data from the Ministry of Health). It is unknown how long this immunity can last, as it is not known how long the defence offered by Sergio Ramos and Gerard Piqué will last in their teams. Possibly, both for the SARS-CoV-2 and for the defensive system of Real Madrid and Barça, it is necessary to renew the defences within one or two seasons.

To end this immunity section, treatment with serum from patients recovered from COVID-19, which contain antibodies against SARS-CoV-2, seems to improve COVID-19 patients and helps to slightly increase the percentage of survivors. in the ICU, although a clinical trial of the magnitude required to draw solid conclusions has not yet been carried out 38.


Will they be achieved? —Remember that one hasn’t been created for AIDS—, and if they are, where will phases 3 be done? Will there be places with a high COVID-19 index later to test vaccines at the population level? Will SARS-CoV-2 become extinct, as with MERS, before the vaccine appears? And if the vaccine is obtained, what production and distribution capacity will it have? Who will be vaccinated first? If it has adverse effects on the elderly, the young could be vaccinated for herd immunity that protects the most vulnerable.

The pharmaceutical company Astrazeneca, in collaboration with the University of Oxford, is already preparing the production of some 700 million doses of its vaccine AZD1222, despite the fact that it has not yet passed the phases of clinical trials. Currently, according to an Astrazeneca press release, they have started testing it on some 10,000 volunteers.