Пандемия COVID-19 как индикатор «белых пятен» в эпидемиологии и инфекционной патологии

Пандемия COVID-19 (Coronavirus Disease 2019) выявила множество «белых пятен» в эпидемиологической науке как раз тогда, когда у человечества появилась уверенность в том, что эпидемические катастрофы остались в далеком прошлом. Цель работы – рассмотреть пандемию COVID-19 как индикатор «белых пятен» в эпидемиологии и инфекционной патологии. В статье обосновывается, что эпидемия COVID-19 началась гораздо раньше, чем ее распознали в Китае. Неудачи установления первичного природного резервуара SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) среди позвоночных организмов предполагают расширение круга поисков на беспозвоночные организмы. Причинами глобального распространения SARS-CoV-2 могут быть наличие еще не установленных многочисленных первичных и вторичных природных очагов вируса среди животных в ближайшем окружении человека, высокая трансмиссивность вируса, а также его пресимптоматическая передача. Высокая трансмиссивность SARS-CoV-2 стала возможной благодаря: большей, чем у вирусов близкородственных видов, величине энергии связывания S1-белка вируса с его рецептором ACE2; более эффективному проникновению вируса в эндосомы клетки; работе репликационно-транскрипционного комплекса, противодействующего врожденному защитному ответу клетки. Пресимптоматическая передача SARS-CoV-2, ставшая ключевой в пандемическом распространении SARS-CoV-2 – следствие позднего обнаружения вируса врожденной иммунной системой. Заболевший человек сначала становится заразным для окружающих, а потом у него появляются симптомы болезни. Высказано предположение, что пандемия COVID-19 – не самостоятельное событие, вызванное появлением «нового вируса» (вроде очередной пандемии гриппа), а проявление более сложного и опасного явления – смены фазы многовекового глобального пандемического цикла, когда из-за роста плотности иммунодефицитных и ослабленных различной патологией популяций (хронические болезни, накопление генетических дефектов, старение и др.) и обострившихся социальных проблем на смену нециклическим пандемиям и циклическим малоконтагиозным эпидемиям приходят циклические, вызываемые высококонтагиозными патогенами. SARS-CoV-2 – не последний в этих событиях. К тяжелому клиническому течению COVID-19 приводят такие еще малоизученные процессы, как «разбалансировка» ренин-ангиотензин-альдостероновой системы, цитокиновый шторм, септическое течение болезни, генетические факторы пациента и развившаяся в ходе инфекционного процесса иммунопатология (антитело-зависимое усиление инфекции, антигенный импринтинг, антифосфолипидный синдром, наличие антиинтерфероновых антител и др. факторы). Заполнение этих «белых пятен» станет катализатором исследовательской революции в эпидемиологии и инфекционной патологии.

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