A 25-year-old man has the first case of confirmed COVID-19 reinfection in the U.S., and his symptoms were worse the second time.
This is only the fifth confirmed case of reinfection in the world.
Infectious disease experts explain how a person can become ill from the novel coronavirus twice, and how common it is known to be so far.
Back in August, a case report surfaced that told the story of a man in Hong Kong who was re-infected with COVID-19, just four months after contracting the virus. Now, there’s a similar case in the U.S.
A 25-year-old Nevada man was re-infected with COVID-19 in late May after contracting the novel coronavirus just a few weeks before, according to a case study published in The Lancet Infectious Diseases. The man, who has not been publicly identified, first developed symptoms of the virus, including a sore throat, headache, and gastrointestinal issues, in late March. He tested positive for SARS-CoV-2, the coronavirus that causes COVID-19, in mid-April and recovered by April 27.
The man was re-tested for the virus in May and tested negative twice. But just two days after his second negative test—on May 28—the man developed a fever, cough, and dizziness. This time, he ended up in the emergency room with shortness of breath and tested positive for the virus again in early June. While he survived, “the second infection was symptomatically more severe than the first,” the researchers wrote in the case report.
“These findings suggest that the patient was infected by SARS-CoV-2 on two separate occasions by a genetically distinct virus,” they added. “Thus, previous exposure to SARS-CoV-2 might not guarantee total immunity in all cases.” The researchers urged everyone “whether previously diagnosed with COVID-19 or not” to “take identical precautions to avoid infection with SARS-CoV-2.”
Should you be worried about COVID-19 reinfection?
Experts stress that you should not panic. “This patient clearly got re-infected, but there are many questions around this: How many people do you have to look at to find this? Is this the normal way the virus behaves or not?” says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security.
“These are very rare occurrences and it’s likely that there is some biological explanation for why this person is susceptible, but it’s not what we’re seeing in millions of other people,” Dr. Adalja adds. “There have only been a couple of documented cases of reinfection in close proximity.”
However, it’s possible this is happening more often that scientists realize, says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine. “There could be other patients that had two cases, but it just wasn’t documented the way this patient’s case was,” he says.
Currently, the Centers for Disease Control and Prevention (CDC) says that people who develop new symptoms of COVID-19 more than three months after they first experienced signs of the virus should be re-tested and self-isolate, as they would be considered infectious.
But how is it possible to get COVID-19 twice?
Currently, the CDC says that it’s “unlikely” that people will be re-infected shortly after they recover from the virus, but that “more information is needed.”
How someone can get re-infected with COVID-19 in such a short frame of time is still a bit of a mystery. “We don’t know at the moment whether these are biological outliers or might actually be a fore-taste of others like them in the future,” says Dr. Schaffner.
With other human coronaviruses, like the ones that cause the common cold, “your protection generally wanes, starting after about a year,” Dr. Schaffner explains. As a result, you can get re-infected with the same strain the following year. “But all of these coronaviruses are different, so we can’t expect the same thing from COVID-19,” he says.
The severity of infection the first time around may matter, too, says Shobha Swaminathan, Ph.D., associate professor at the Rutgers New Jersey Medical School and medical director of Infectious Diseases Practice at University Hospital. “It is possible that the first time around, the person may have had a mild infection,” she says. As a result, the man in the case report may not have built up strong antibodies and end up susceptible to re-infection quickly.
But while this does seem to be rare at this point, it’s likely more cases of re-infection will surface in the future, “given that we don’t see any signs that the pandemic is getting any better,” says Richard Watkins, M.D., an infectious disease physician and professor of internal medicine at Northeast Ohio Medical University.
Overall, experts say you should keep practicing known ways of preventing the spread of COVID-19 to protect yourself and those around you, including social distancing, good hand hygiene, and wearing masks in public—whether you’ve already had COVID-19 in the past or not.
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