Second Time Around

President Trump in Sanford, Florida, Oct

 12, 2020. Photo Saul Loeb/AFP

"I feel so powerful. I'll walk into that audience. I'll walk in there, I'll kiss everyone in that audience. I'll kiss the guys and the beautiful women ... Everybody." 

"I'll just give you a big fat kiss."

"They say you're immune. I don't know for how long. Some people say for life, some people say for four months."

U.S. President Donald Trump

"We have to stop and remind everyone that this may not be generalizable. [In biology, everything happens across a spectrum], and this may be the absolute, very rare end of the spectrum [of immunity once naturally exposed to the SARS-CoV-2 virus]."

"We don't necessarily have a system that's well designed to find reinfection cases and as such, I'm unwilling to say how often it does happen. It very well might be very rare. But it very well might not be as rare as we think. We just need a better surveillance system for it."

"[From a public health perspective], people who have had COVID-19 should behave and be treated as if they had not had the virus, because now we know it's at least possible to be reinfected and for the infection to lead to significant illness."

"You can be really unlucky and just get slammed by a very high viral load [the second time around, making you more sick with the second infection than the first]."

"The virus that came out of the gate earlier in the year is not the same virus, identically, as the one circulating in North America right now."

"Viruses can trick our immune system pretty well, in a natural context. But vaccines are engineered or designed to go after the Achilles heels of these viruses. I think we can still remain optimistic that this does not spell doom for vaccinology."

Dr.Mark Pandori, director, Nevada State Public Health Laboratory

"Not only is this strategy [herd immunity] lethal for many but also it is not effective. Herd immunity requires safe and effective vaccines and robust vaccination implementation." 

"We are probably severely underestimating the number of asymptomatic reinfections."

Akiko Iwasaki, professor of immunology, Yale University

Confirmed cases of COVID-19 reinfection raise concerns about how common it might be and how effective a vaccine will be as the virus appears to mutate.  CBC

 

It is an acknowledged fact that there is no hard knowledge to predict how long or how well immunity lasts after an infection with SARS-CoV-2. There is ample speculation, from laboratories all over the world, and in the White House, but questions abound. The case of a 25-year-old man from Washoe County, Nevada was explored in a paper published in Lancet Infectious Diseases this week; Dr.Pandori the lead author. The man possessed no known immune disorders, nor did he have any underlying health conditions. Within a 48-day period, the young man was twice infected, each time by two distinct SARS-CoV-2 viruses.

Though there are no hard figures on how many people have been infected more than once with COVID-19, his is the fifth such confirmation, worldwide. In April the man first tested positive for the virus after several weeks of COVID symptoms including sore throat, cough, headache, nausea and diarrhea. He recovered in April and was fine into May. He tested negative in two consecutive tests. At the end of May fever, headache, dizziness and cough and shortness of breath returned. Admitted to hospital in early June he once again tested positive for COVID, but this time developed a pneumonia-like illness for which oxygen was required.

In another case an elderly Dutch woman with a rare white blood cell cancer developed COVID symptoms two months following the start of her first infection episode, two days after starting chemotherapy. Two weeks later, she died. The genetic makeup of the virus was different each time, suggesting "it is likely that the second episode was a reinfection rather than prolonged shedding" from the first, according to a report by researchers published in the Oxford University Press.

Researchers are now agreed that those who have tested positive for COVID-19 and recovered should resume a regimen of precautionary measures, including distancing, masking and rigorous hand-washing. Not all reported second cases turn out worse than the original. And it is theorized that some infectious doses can be overwhelmingly high; higher the second time around than the first, leading to a more serious illness experience.

Dr.Pandori explains that vaccine-based immunity is quite different from an in-body immune response; they are developed specifically to recognize the virus and resist it, whereas such viruses have the capacity to 'trick' and confuse a natural immune response. There are close to 40 million confirmed COVID infections globally. "These small examples of reinfection are tiny and should not deter efforts to develop vaccines", stated Brendan Wren, a professor of vaccinology at the London School of Hygiene & Tropical Medicine.

 

Protective face masks with flag designs are seen on display in a shop in Paris. Scientists said that while known incidences of reinfection appear rare, such cases of COVID-19 were worrying. (Charles Platiau/Reuters)