An 89-year-old woman from the Netherlands died after being reinfected by the coronavirus. It would be the world’s first case of a fatal outcome of the second infection. The woman – reports El Mundo – was being treated for Waldenstrom’s macroglobulinemia, a rare type of cancer. Earlier this year she was admitted to the emergency room with a high fever and cough. After testing positive for coronavirus, she had fully recovered after 5 days. Almost 2 months later, and just two days after a new course of chemotherapy, she again had a fever, cough and breathing problems and tested positive for coronavirus again. On the eighth day of hospitalization her condition worsened and she died 2 weeks later.
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The world’s cases of reinfection
The analyzes carried out on the woman confirmed that the genetic makeup of the virus was different in each of the two infections. To date, approx 23 cases of reinfection around the world, sometimes with better outcome and sometimes worse than the first time. Just these days the official publication in the scientific journal Lancet a study on the world’s second documented case of reinfection (first in the US) reported in August (we talked about it WHO). It was a 25-year-old from the state of Nevada who got sick for the first time last April after suffering from a sore throat, cough, headache, nausea and diarrhea. The boy, who recovered towards the end of that month, became ill on May 31st with the same symptoms, which in the second case had forced him to hospital for respiratory failure. This is the other peculiarity of the case (the worst course), besides reinfection.
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What do we know
Commenting on the study describing the 25-year-old’s story his Lancet, an editor at the firm Akiko Iwasaki, Yale Professor of Molecular Cellular and Developmental Biology, taking stock of what we know so far about reinfections by answering four questions.
The first is if reinfections occur due to a poor antibody response. Of the four official reinfection cases – writes Iwasaki -, that is with genomic sequences analyzed both after the first infection and after the second and accompanied by official studies, none had immune deficiencies. Currently, only two individuals had serological test data relating to the first infection and, due to the variety of kits adopted in all countries of the world, it is impossible to compare the results with each other. Moreover – writes the expert -, the levels of antibodies strongly depend on how much time has passed after exposure to the virus. There are insufficient data and studies.
Second question: does immunity protect an individual from disease in case of reinfection? The answer “not necessarily”, given that at least two reported cases (from Nevada and Ecuador) had worse disease outcomes in the second reinfection than in the first. It is important to keep in mind – warns the doctor – that cases of reinfection in general are reported when they are symptomatic, so we do not know how often reinfection occurs among people who have recovered. We are probably underestimating the number of asymptomatic reinfections. As to why there is sometimes a more serious disease, further investigation is needed on the pre-existing immune responses and on the viral load recorded in both infections.
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Third point: does getting infected with viral strains with different characteristics mean that we will need a vaccine for each type of viral variant? Although the differences in the viral genome sequence are a great way to really know if an individual is being reinfected, or if it is a virus still latent in the body (and therefore a relapse), this does not indicate that the second infection is due to an immune deficiency. There is currently no evidence that a significant variant of SARS-CoV-2 has emerged. For now, one vaccine will be enough to confer protection against all circulating variants.
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Does immunity prevent transmission from those who are reinfected? In some cases of reinfection it is thought that the infectious virus may have been lodged in the nasal cavity. Therefore, cases of reinfection tell us that we cannot rely on antibodies to point to herd immunity. People who become infected a second time could also be contagious. Herd immunity – writes Iwasaki – requires safe and effective vaccines and a solid implementation of vaccination campaigns.
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13 October 2020 (change October 13, 2020 | 17:10)
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