Covid-19: New cases of reinfection reinforce need for care even after recovery

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There is still no robust evidence on the immunity that Covid-19 can confer after infection. In addition, some cases, to a lesser extent, have demonstrated the possibility of reinfection by the disease, having been confirmed in August by genetic sequencing, the first of which was in Hong Kong.

Two other European reports were published after the first release, in addition to one from a patient from Ecuador. This week, the Lancet published yet another case of possible reinfection, this time in the United States.

Covid-19 Reinfection

A 25-year-old Nevada resident took a test at a community event held in the district where he lived on April 18. He has had symptoms such as sore throat, cough, headache, nausea and diarrhea since 25 March. RT-PCR, collected by swab nasopharynx, tested positive for SARS-CoV-2.

Read too: Challenges of Covid-19: Is recurrence or reinfection possible?

The patient reported on April 27 that the symptoms had ceased during isolation. Two tests carried out later gave negative results for infection. However, the patient felt good only until May 28. Three days later, he attended the emergency with fever, headache, dizziness, cough, nausea and diarrhea. A chest X-ray was performed and he was discharged home.

On June 5, the man went to a primary care unit, where he reported dyspnoea and the doctor identified hypoxia. He was instructed to go to a hospital, where he was admitted to receive continuous oxygen and a second swab was collected, showing a positive result. The man reported symptoms such as myalgia, cough and shortness of breath.

A new chest X-ray showed the development of irregular, bilateral interstitial opacities, suggestive of viral or atypical pneumonia.

Results

As the patient presented two positive results, with negative intervals between them, nucleic acid sequencing of the viruses associated with the tests was performed. Illumina sequencing demonstrated that the first specimen (A) had five single nucleotide variants (SNVs), while sample B had six additional and a mutation at position 14.407.

These findings were confirmed by further analysis of FASTQ files generated from samples A and B.

See more: Covid-19: What is the new evidence on protective immunity?

Conclusions

The man did not have immunocompromise, nor did he use an immunosuppressant. In addition, no abnormalities in cell count were observed. The second infection occurred concurrently with a case of a close contact, who lived at home: his father.

It is possible to state, after analysis, that the second infection occurred due to a mutation of the SARS-CoV-2 virus. Unlike the first three cases of reinfection (Hong Kong, Belgium and the Netherlands), the patient in the United States had greater severity after reinfection, a pattern more similar to the case of Ecuador.

One of the limitations presented is that the patient’s immunity profile was not evaluated after the first infection. In addition, it was not possible to identify which mechanisms may be responsible for the new infection being more severe.

Even so, cases like this reinforce the need to maintain care and social distance even after recovery.

* This article was reviewed by the PEBMED medical team

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