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COVID-19 parties? The idea of intentionally exposing individuals to COVID-19 has been proposed. It is an idea with historical precedent—chicken pox parties, rubella parties, and even smallpox parties had the goal of intentionally exposing people to a virus. So, why should people resist the temptation to intentionally expose themselves or their children to COVID-19? How should healthcare providers respond to patients and families who pose this question?
Deliberate COVID-19 Exposure: The Risks
Despite more than 117,000 US deaths (and counting) over the span of only a few months, current data suggest that about 80% of people infected with COVID-19 do not get severely ill. This suggests that four of every five people would "get away with" intentional exposure without experiencing severe consequences. However, this way of thinking discounts some important risk-related considerations for the person being exposed and those around them.
Duration of immunity. Several questions about COVID-19 immunity remain unanswered, including whether infection protects against reinfection and, if so, for how long. Antibody duration and the significance of particular antibodies, such as neutralizing antibodies, also remains elusive.
Further, we have yet to understand the role of antibodies in the resolution of disease or the ability of a person to spread the virus. Although experience with other pathogens can help us predict how long immunity will last, hypotheses are not data; the reality is that duration of immunity and protection from reinfection remain unknown. Intentional exposure may not lead to long-term immunity nor protect against reinfection—the very goals of the action.
Long-term consequences of infection. At the outset of the pandemic, experience with hospitalizations and severe disease suggested that children were, for the most part, spared. Then, reports started to appear about multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Growing evidence suggests MIS-C can occur in previously asymptomatic children and, in at least some cases, well after the start of infection, as evidenced by IgG-positive serology. Additionally, this so-dubbed "Kawasaki-like" syndrome appears to be more severe than the disease after which it was named, with increased cardiac-related symptoms and macrophage activation syndrome, as well as varying effects on several other organ systems. In a UK case cluster, seven of eight children required mechanical ventilation support, and one child died.
Likewise, the long-term or delayed-onset effects on adults who survive severe infections remain uncertain, but pulmonary, neurologic, and cardiovascular damage, including stroke, have been reported.
Important to the consideration of deliberate exposure is that we can't predict which people will experience these types of complications.
Asymptomatic transmission. Intentional exposure also has community implications. Neither presymptomatic nor asymptomatic transmission have been ruled out. Although someone choosing to deliberately expose themselves or their child could presumably self-quarantine for 14 days to prevent transmission, this would require an adherence to self-quarantine measures by everyone living in the home. Given that up to 40% of infected individuals could be asymptomatic, it is not difficult to anticipate that those family members could opt to go to work or run errands. Further, as society "reopens," the likelihood of adhering to a minimum 2-week self-quarantine will presumably decrease and be compounded by lack of adherence to social distancing recommendations, as indicated by numerous videos from Memorial Day events and recent protests.
So, before making a decision about intentional exposure, your patients should consider the commitment required to remove themselves, and those around them, from society for 14 days—and possibly longer if someone in the home gets sick.
Severity of secondary cases. One thing that is clear is that people with mild illness can transmit COVID-19 to others, who then become severely ill and, in some cases, die. Although this may not be surprising, it is a reminder that people aren't just making a choice for themselves but also for those with whom they come in contact. This is of particular concern for family members with high-risk conditions. Likewise, individuals may become sick enough that they cannot care for themselves, further increasing their risk to others.
Limited healthcare resources. The reason society shut down was to "flatten the curve," thereby providing important time to shore up resources and learn more about this new virus, especially how to treat it. Although we are in a better place, much remains to be learned.
Likewise, communities could still quickly be overwhelmed by a spike in cases. Officials monitoring hospital resources currently indicate that available ICU beds are limited in more than half of US states.
As such, before considering deliberate exposure, people should realize that treatments for those who become severely ill remain experimental at best and available resources may be limited in their community.
© 2020 Children's Hospital of Philadelphia and Medscape
Cite this: Coronavirus Parties Are a Bad Idea - Medscape - Jun 18, 2020.