Infectious Disease

SARS-CoV-2 reinfection price ‘in all probability increased’ than beforehand assumed

February 15, 2021

2 min read

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A 43-year-old man in the United States tested positive for SARS-CoV-2 twice within 4 months, according to an article in BMJ Case Reports.

The researchers said the case highlighted the possibility of SARS-CoV-2 re-infection and an opportunity to expand the “limited data” available on SARS-CoV-2 re-infection.

“We felt it was important to document this case report of suspected COVID-19 reinfection to further elucidate the natural history of COVID-19 reinfection.” Jessica Tuan, MD, MS, Healio Primary Care, a staff member in the internal medicine department at Yale University School of Medicine and a co-author of the newspaper, told Healio Primary Care.

According to the senior co-author, concerns about re-infection increase as new variants emerge who knows Ogbuagu, MBBCh, FACP, FIDSA, Infectious Disease Specialist and HIV Clinical Trial Director in the Yale AIDS program. He warned that people previously infected with previous SARS-CoV-2 strains “are immediately prone to re-infection with emerging variants such as the South African strain”.

Below, Tuan discusses the incidence of SARS-CoV-2 reinfection, the dwindling immunity, the severity of the disease upon reinfection, and much more.

Q: How many known cases of reinfection with SARS-CoV-2 are there?

A: As of September 2020, there were six documented cases of COVID-19 reinfection worldwide, according to the European Center for Disease Prevention and Control. So far, the number of confirmed cases has risen to 47, although the number of suspected cases is much higher.

The current number of definitive reinfection cases of COVID-19 is unclear as there is no sequencing and underreporting capacity readily available for the identification of reinfection cases. With these capacity issues, combined with increasing circulating SARS-CoV-2 variants, the number of COVID-19 reinfection cases is likely higher than previously thought.

Q: What evidence suggests these cases are reinfections rather than persistent viral shedding?

A: A definitive diagnosis of COVID-19 reinfection would be confirmed via separate SARS-CoV-2 strains identified in separate COVID-19 episodes. However, negative COVID-19 tests with multiple intervals and a relatively high SARS-CoV-2 viral load (or a low cycle threshold) on a second presentation also suggest a renewed COVID-19 infection. If the SARS-CoV-2 virus can be cultured on a second episode, this likely indicates re-infection as well, rather than a non-viable, non-infectious virus.

Q: How do people get infected again?

A: People are likely to become re-infected due to dwindling immunity, which increases the risk of COVID-19 re-infection as well as underlying host factors such as a history of immunosuppression. These factors, combined with increased levels of circulating SARS-CoV-2 variants, make individuals more prone to COVID-19 reinfection. In the case of mutations in this virus, the principle of survival of the most suitable mutation applies.

Q: How long does it take on average between the initial infection and re-infection?

A: Previous studies have documented a period of 10 to 185 days between the time of the first COVID-19 episode and an episode of COVID-19 reinfection. Recent data from documented COVID-19 reinfection cases suggest that the average interval between episodes is approximately 85 days.

Q: Is the severity of the disease better or worse the second time? Why?

A: The severity of illness can vary as a result of a COVID-19 reinfection. In our patient, the first episode of COVID-19 was severe, followed by a milder case of COVID-19. The variable representation of the severity of the disease with re-infection is likely to be related to the persistence of immunity, the SARS-CoV-2 strain with re-infection and the host factors including the underlying history of immunosuppression.

Reference:

Tuan J, et al. BMJ Case Rep. 2021; doi: 10.1136 / bcr-2020-240531.

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