Health
The first American case in which a Nevada man was identified
The otherwise healthy 25-year-old Nevada man was the first American to be confirmed to have been infected twice with COVID-19, and the second infection was worse than the first.
He recovered, but his case raises questions about how long people will be protected and potentially how much the vaccine will be protected after being infected with the cause-causing coronavirus. ..
“This is a yellow warning light,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine in Nashville, Tennessee, who was not involved in the study.
Respiratory tract infections such as COVID-19 do not provide lifelong immunity like measles infections. So Dr. Paul Offit, an infectious disease expert at the Children’s Hospital of Philadelphia, said he wasn’t completely surprised that people could be infected with the coronavirus SARS-CoV-2 twice.
It is premature to know if it is very rare for a man in Washoe County, Nevada to have no health problems other than superinfection, or if many are susceptible to multiple SARS-CoV-2 infections. That’s what Schaffner said.
“There are few infectious disease doctors in the country who have never met a patient who thinks they have had a second infection,” he said. “I don’t know if that’s true. There are a lot of respiratory infections out there.”
How unusual is he?
At least there was 22 reinfections have been recorded worldwide It is unclear how many cases have actually occurred since the pandemic began and how common it is among people who do not even know they are infected.
“It could be a once-in-a-million event,” said Akiko Iwasaki, an immunologist at Yale University and a researcher at the Howard Hughes Medical Institute.
With millions of people infected, she said it’s hard to tell if the new case study represents a very rare event or the tip of the iceberg. “The majority of people may be completely protected from reinfection, but we haven’t measured them because they haven’t come to the hospital.”
Also, many people don’t know that they have been infected for the first time, so I don’t know if they have been re-infected.
In one of the recent cases Hong Kong men He was caught during regular screening when he returned from abroad, so he only knew he had re-infected a few months after he cleared the infection and was negative.
Mark Pandri, a pathologist at the University of Nevada’s Reno Medical College, said one of the reasons why there may be no more recorded cases of reinfection is difficult to prove. Senior author of new research..
His team coordinated with members of the Washoe County Health District early in the pandemic to repeatedly look for infections. They had the advantage of sequencing equipment on campus as well as microbiologists, he said. And they were fortunate to find someone who was tested both times he was infected and cleared in the meantime.
Pandri, director of the Nevada Institute for Public Health, said it was unclear why his infection worsened a second time. “I don’t know if it can tell us anything in particular about the biology of this virus.”
Genetic analysis of male infections showed that the male caught a slightly different version of the virus a second time. There is no evidence of that, but the second version could have been more dangerous, or was different enough that his body didn’t recognize it, the paper said.
Impact on vaccination
According to Iwasaki, the study raises questions about the duration of immunity after natural infection. Vaccine protection is likely to be quite different, she said.
“Vaccines can be designed to induce much higher levels of antibodies and much longer lasting immunity,” she said. Just because a natural infection does not give you protection does not mean that you cannot get a vaccine. Another problem. “
Ofit, a vaccine expert at the University of Pennsylvania’s Perelman School of Medicine, said he expects vaccine protection to last for at least a year or two.
He said the protection provided by infections and vaccinations is not 100% complete until the day it disappears altogether. Instead, protection is gradually weakened, so people exposed to large numbers of viruses can be re-infected within a few months, while others can be protected for years, Mr. Ofit said. Stated.
Men in Nevada may also have problems with their immune system that have not been diagnosed. “He should probably be seen by immunologists,” Ofitt said.
The length of time the infection is protected is one of the important open questions about the virus.
Infected twice every two months
A man in Nevada, who was considered an essential worker, began to feel sick in late March with a sore throat, cough, headache, nausea and diarrhea. Heather Kirwin, a senior epidemiologist and co-author of the paper in Washoe County Health District, said his workplace occurred early in the pandemic before taking safety measures such as masks.
He went to the test on April 18 and was confirmed to be infected with the coronavirus.
On April 27, he reported that all his symptoms had disappeared and he felt better, but at that time employees had to test for COVID-19 twice negative before returning to work, Carwin said. Stated. So he remained isolated at home.
A month later he began to feel sick again. At the same time, there was an outbreak in which one of his parents, as well as an essential worker, was hired, Kirwin said.
On May 31, he went to an emergency medical center and reported fever, headache, dizziness, cough, nausea and diarrhea. On June 5, he noticed that his oxygen levels were dangerously low and was seen by a doctor who was hospitalized. According to Carwin, the man tested positive for the virus, even though he still had antibodies to the virus in his bloodstream.
Genetic differences between the viruses responsible for each of his infections suggested that he was infected twice separately. Researchers have found that the virus does not mutate in a single human fast enough to explain the difference between the two infections.
Parents living with a man were also infected with COVID-19 and were diagnosed on June 5.
The paper reports that the man may have been re-infected due to a second high-dose exposure to the virus, probably from his family.
According to Kirwin, he had a prolonged cough and suffered from shortness of breath and mental fog, and had been taking oxygen for six weeks after the second infection. He is now fully recovered.
Reinfection means that so-called herd immunity cannot be obtained by natural infection alone. If the natural infection is protected for only a few months, it is not possible to protect enough people at the same time to reach herd immunity.
According to co-author Pandri, the lesson of this case study is that even people who are already infected with COVID-19 wear masks, avoid large gatherings, wash their hands frequently, and keep social distance. It means that you need to protect yourself by maintaining it.
“You are not invincible to this,” Pandri said. “In fact, the second time can get worse.”
Please contact Karen Weintraub ([email protected]) and Elizabeth Weise ([email protected]).
Health and patient safety coverage at USA TODAY was partially made possible by grants from the Masimo Foundation for Ethics, Innovation and Competition for Healthcare. The Masimo Foundation does not provide editorial input.
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