A 25-year-old man has become the first person in the US to be struck down with the coronavirus for a second time – which struck him harder than his first bout of the disease.
The unidentified patient first tested positive in April after showing mild symptoms of a sore throat, cough, headache, nausea and diarrhea. But, after recovering and receiving two negative tests, he began experiencing similar warning signs in May.
He tested positive – 48 days after the first negative test – and suffered a more severe infection. He was hospitalized, required oxygen, and endured coughs, muscle aches and shortness of breath. An X-ray also suggested viral pneumonia, which can be deadly.
Genetic sequencing reveals the patient, of Washoe County in Nevada, was infected by two different strains of coronavirus. He is the world’s fifth known cases of COVID-19 re-infection.
The truth on COVID-19 immunity remains a mystery because the pathogen, known as SARS-CoV-2, has only been known to science for less than a year. But scientists are convinced the disease will be milder the second time round because the body will have already built up some natural immunity against it.
The latest case, published in The Lancet Infectious Diseases, challenges that theory and poses questions for any future vaccination programs, as well as those countries pushing a herd immunity strategy.
Experts described the case as ‘very concerning’. It comes after President Donald Trump controversially claimed he is immune to the virus and has a ‘protective glow’ that means he ‘can’t get it and can’t give it’.
This shows a timeline of the unnamed 25-year-old man’s two coronavirus infections. He is from Washoe County in Nevada. Genetic testing revealed he had been infected by two different strains of coronavirus
The chart above shows the various genetic strains of coronavirus. The two that infected the 25-year-old man are highlighted as specimen A (left) and specimen B (top right). The first virus is highlighted as Wuhan Hu 1 (mid-left). Mutations in the virus mean it could have different proteins on its surface, making it harder for the body’s immune system to fight it off
The American man was not named and had no underlying health conditions.
Although this doesn’t prove contracting the virus will not result in herd immunity, the scientists said everyone should observe protective measures including wearing a face mask, social distancing and hand washing.
Dr Mark Pandori, from the Nevada State Public Health Laboratory and who led the study, told DailyMail.com the patient may have received a ‘very high dose’ of the virus to become re-infected. This would have ‘overwhelmed’ the immune system, he said, leading to a more serious infection.
Re-infections may be occurring across the US, he warned, but that most are likely asymptomatic and hence going undetected.
‘If [that] is happening, we would have no way of knowing it,’ he said.
‘People wouldn’t feel inclined to get tested again. It’s also hard to confirm a re-infection case. Some labs are barely keeping hold of testing, let alone rest testing.’
He said the case ‘strongly suggests’ individuals should continue to take serious precautions against the virus including wearing a face mask, social distancing and handwashing.
This graphic highlights the points on the genetic code that specimen A and specimen B coronaviruses differed. Experts argued that these changes could have allowed re-infection
CAN YOU CATCH COVID-19 TWICE?
Early on in the pandemic, scientists were baffled as to whether or not you could catch Covid-19 twice. Now the evidence is more convincing, following a string of reports of re-infections all over the world.
With some illnesses such as chickenpox, the immune system can remember exactly how to destroy it and becomes able to fend it off if it ever tries to enter the body again.
Tests have shown that many people who recover from Covid-19 have antibodies – which can produce future immunity – but it is not known whether there are enough of them.
However, antibodies are only one type of substance that can produce immunity. The immune system is a huge web of proteins that have different functions to protect the body against infection.
Others, including white blood cells called T cells and B cells, can also help the body to fight off disease but are more difficult to discover using currently available tests.
Evidence is beginning to suggest that antibodies disappear in as little as eight weeks after infection with the coronavirus, scientifically called SARS-Cov-2.
On the other hand, T cells – which target and destroy cells already infected with the virus – are ‘durable’.
A promising study done on monkeys found that they were unable to catch Covid-19 a second time after recovering from it, which led scientists to believe the same may apply to humans.
The rhesus monkeys were deliberately reinfected by scientists in China to test how their bodies reacted.
Because the coronavirus has only been known to scientists for nine months there has not been enough time to study whether people develop long-term immunity.
After the patient tested positive for the virus at Washoe County Health District on April 18, he was isolated for treatment. Doctors waited for the symptoms to subside, and completed two negative tests, before giving him the all-clear to go back into the community.
But he started suffering the same warning signs on May 28, including dizziness.
He was rushed to urgent care but discharged after a chest X-ray returned no results.
After the symptoms persisted for five days he went to a primary care physician who diagnosed hypoxia, which occurs when the tissues do not have enough oxygen to sustain bodily functions.
The patient was sent to an emergency room and swabbed – where he tested positive for COVID-19.
He suffered a more severe bout of the illness, from which he has recovered.
Of the four other confirmed re-infections two, a 46-year-old man in Ecuador and 86-year-old woman in the Netherlands, suffered a more severe bout of the disease. The man eventually recovered without needing hospitalization but the woman died.
Dr Pandori added: ‘I think [the study] shows that whether you tested positive or not, we’re all in the same public health boat together.
‘Be considerate that you might be able to get infected again because we cannot prove invulnerability.
‘Mask wearing and social distancing apply just as much to those who have had the virus as those who have not.’
Professor Brendan Wren, of vaccinology at the London School of Hygiene and Tropical Medicine, told The Times the case suggests a COVID-19 vaccine may ‘not be totally protective’.
‘However, given the 40million cases worldwide these small examples of re-infections are tiny and should not deter efforts to develop vaccines,’ he said.
Dr Simon Clarke, an expert in cellular microbiology at the University of Reading, added it was still too soon to tell how common re-infection could be.
‘The implications of more widespread re-infections are that herd immunity would not work,’ he said.
‘This provides further scientific evidence for extreme caution in proposing policies that allow Covid-19 to rip through the younger population while attempting to shield the elderly and vulnerable, even if that were possible, which it probably isn’t.’
Scientists are still unsure on the truth on immunity because Covid-19 has only been around since January – meaning its long-term effects are still unclear.
So far cases of people getting infected more than once have not been numerous nor convincing.
In August, two European COVID-19 survivors were reportedly re-infected after recovering from the disease; a Dutch patient who was old and had a weakened immune system and a Belgian woman who only had mild symptoms tested positive twice, local broadcasters claim.
It followed a landmark report of a Hong Kong man who was re-infected four and a half months after he was originally struck down. Genetic analysis revealed the 33-year-old’s second bout of the disease, which he caught on a trip to Europe, was caused by a different strain of the virus.
Professor Paul Hunter, an infectious disease specialist at the University of East Anglia said: ‘I think most of us have thought that reinfection with COVID-19 was likely to become common as individuals’ immunity levels declined post infection.
‘However, the findings… are very concerning both from the point of view of the very short time between the two infections and the fact that the second illness was more severe than the first.
‘Until this and one other recent report from Ecuador I for one assumed that any second infection was likely after only a few months and then most likely to be less severe, at least in otherwise immune competent individuals.
‘Indeed, apart from this US and the Ecuadorian cases, other reports of reinfection have tended to be asymptomatic.’
What are the cases of people being re-infected with coronavirus?
Ecuador: Man, 46
First infection: Mild. Second infection: Severe
A 46-year-old man suffered a more serious bout of infection when he caught the virus for a second time. After first catching the virus in May, and later testing negative, he was swabbed again in August after showing mild symptoms, and found to have been re-infected. He suffered worse symptoms, including fever, a headache and a sore throat but did not require hospitalisation. In the first infection he experienced a headache, sore throat and fatigue. Genetic sequencing showed he was infected with two different strains of the virus.
Dutch: Woman, 86
First infection: Mild. Second infection: Death
An 86-year-old woman died after she was re-infected by coronavirus. She recovered from the first case but two months later she developed a fever, cough and shortness of breath. Covid-19 was diagnosed again. The infection happened after she started a course of chemotherapy for an underlying health condition. Genetic studies revealed she was infected by two different strains of the virus.
Belgium: Woman, 50s
First infection: Mild. Second infection: Mild
A woman in her 50s suffered a second infection in June after first contracting the virus in March. Belgian virologist Marc Van Ranst has not made the details of the case public, but claimed the woman developed very few antibodies after her first infection, suggesting this made her more susceptible.
Hong Kong: Man, 33
First infection: Mild. Second infection: Mild
A 33-year-old man who was infected with the virus in March suffered a second infection in August. He was tested again after returning from a trip to Spain via the UK, and was found to be positive for Covid-19. He did not suffer any symptoms with the second infection, which scientists said may show re-infections are generally milder.
Source: International SOS