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Scientists are reporting several cases of Covid-19 reinfection — but the implications are complicated

Mary Wilson

Well-known member
By ANDREW JOSEPH

AUGUST 28, 2020

Following the news this week of what appears to have been the first confirmed case of a Covid-19 reinfection, other researchers have been coming forward with their own reports. One in Belgium, another in the Netherlands. And now, one in Nevada.

What caught experts’ attention about the case of the 25-year-old Reno man was not that he appears to have contracted SARS-CoV-2 (the name of the virus that causes Covid-19) a second time. Rather, it’s that his second bout was more serious than his first.

Immunologists had expected that if the immune response generated after an initial infection could not prevent a second case, then it should at least stave off more severe illness. That’s what occurred with the first known reinfection case, in a 33-year-old Hong Kong man.

Still, despite what happened to the man in Nevada, researchers are stressing this is not a sky-is-falling situation or one that should result in firm conclusions. They always presumed people would become vulnerable to Covid-19 again some time after recovering from an initial case, based on how our immune systems respond to other respiratory viruses, including other coronaviruses. It’s possible that these early cases of reinfection are outliers and have features that won’t apply to the tens of millions of other people who have already shaken off Covid-19.

“There are millions and millions of cases,” said Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health. The real question that should get the most focus, Mina said, is, “What happens to most people?”

But with more reinfection reports likely to make it into the scientific literature soon, and from there into the mainstream press, here are some things to look for in assessing them.

https://www.statnews.com/2020/08/28...m_source=twitter&utm_campaign=twitter_organic
 
Kudos to the author of this article (Andrew Joseph) particularly as he is listed as a 'general assignment reporter' not a science reporter. It is clear, accurate and he has been talking to the right people, based on the quotes.
The Hong Kong case is the only one that I know of with confirmed second infection, as apposed to recurrence of the the original infection. This is due to the availability of both sequences for full genome sequencing showing a too low homology to be the same virus. In that case he had 3 PCR positive tests in his first infection but all had CT scores of 30+ which is probably too low a viral load to be infectious by an order of magnitude and insufficient to generate a detectable antibody response. The second infection was asymptomatic but with lower CT values (indicating a greater viral load) and did generate an antibody response.
This is what you would expect if the first infection added some level of T-cell production to aid the innate immune response so the second infection was more quickly controlled, without the over production of inflammatory cytokines, which are what we experience as symptoms.
 
The case in Ecuador is a new infection but I could not see anything in the others to show if it is recurrence or reinfection. In the Ecuadorian case the patient had a worse case second time around, which is concerning. While the immune system may clear virus without producing antibodies it should not make matters worse for a second infection. We will need more confirmed reinfection with better data to try and work out why this is happening - assuming it is not just a one-off in this patient.
Can anybody else think of a plausible explanation, beyond random chance?
 
With just a handful of cases, it could be that the reason the second infection is worse is that the host health status has changed for some reason over time. I think we need to see more cases to fear a dengue-like phenomenon is happening.
 
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