In Baden-Württemberg, a man died for the first time after being infected again with the coronavirus. This was confirmed by the State Health Office in Stuttgart at the request of WDR, NDR and SZ.
By Florian Flade and Markus Grill, WDR / NDR
According to the State Health Office, the 73-year-old man from the Freudenstadt district in Baden-Württemberg fell ill with the corona virus for the first time in April last year. In December he was then infected again and died on January 11 this year “of Covid-19 pneumonia and sepsis with multiple organ failure,” as the regional council of Stuttgart announced on request.
Because he had a long symptom-free phase and now his wife is infected the second time, these are “strong criteria” for an actual reinfection, says Christine Wagner-Wiening, deputy head of infection monitoring at the State Health Office in Stuttgart, in an interview WDR, NDR and “Süddeutscher Zeitung” (SZ). In addition, the man’s Ct value at the second infection was below 30 – that is, it was more than possibly just virus particles from a first infection. Ct values above 30 are no longer considered to be infectious, and they are often virus residues from a previous infection.
Second infection through mutation?
Whether the man, who also suffered from cardiovascular disease, was infected the second time with the same virus or a mutated form, it could not be said because you no longer have the sample from the first infection from April, so neither can analyze, so the State Health Office. The Freudenstadt district, in which the man lived, was also the first district in Germany in which the virus mutation B.1.1.7, discovered in Great Britain, appeared.
According to the State Health Office, however, there is “no epidemiological evidence” that the deceased came into contact with this mutation. That is why the local health department did not commission a precise virus analysis, so-called genome sequencing. “Only in cases where there is a travel connection to Great Britain, South Africa or Ireland would we notify the health department to initiate sequencing,” explains Christine Wagner-Wiening from the state health office.
Reinfections are very rare
Renewed infections with the coronavirus have so far been rare. The world’s first confirmed case came in August when a man from Hong Kong tested positive again after staying in Spain. However, the second infection was discovered accidentally during a test at the airport because the man had no symptoms. So far, many scientists have assumed that renewed infections are usually mild, as the body has at least a partial immunity after the initial infection.
It is extraordinary that renewed infections lead to death. This is the first known case for the State Health Office in Stuttgart. The Robert Koch Institute (RKI) announced on request that reinfections have been reported to the RKI for some time and that a number of these reports are currently being checked.
It is apparently only the third known death worldwide after a corona reinfection. In October, an 89-year-old Dutch woman died, but her immune system was weakened from cancer. In December, an Israeli newspaper reported that a 74-year-old resident of an old people’s home became infected again after surviving the initial infection in August and died, although he had tested negative three times in between.
Experts have been warning for a long time
Experts had repeatedly warned that a survived infection with Sars-CoV-2 does not necessarily protect against renewed infection with the virus. Reinfections were reported again and again around the globe – even if there were not many in the total number. However, there were also cases in which reinfection did not actually take place; here the patients were apparently only infected for a very long time because their immune defense apparently could not fight the virus effectively, so that they were considered reinfected. According to the European Center for Disease Prevention and Control (ECDC), there were observation periods of up to 104 days.
But there were also at least 15 confirmed cases of reinfections in which no virus could be detected in the patients after initially positive PCR tests, before they were suddenly positive again. These patients did not have any immunological limitations. The second infection was usually less severe. Antibodies appear to decrease initially after natural infection.
However, as a rule, the memory cells are still active after six months, according to Michel Nussenzweig’s scientists from Rockefeller University have just publishedby checking the blood of infected people after six months. The strength of the immune response could also have something to do with the severity of the disease, but there is still no information on this.
Consequences for vaccinated people still unclear
What such reinfections mean for vaccinated people is still unclear. However, the vaccination leads to a much stronger immune response than the natural infection. Experts therefore hope that the protection provided by vaccination will last longer. It may also be necessary to re-vaccinate closely.
Reports from Brazil also caused a stir this week about a virus infection leading to renewed infections. Hartmut Hengel, head of virology at the University of Freiburg, assumes that reinfections are even “widespread” in Brazil. “There is now a certain population immunity there, which means that the virus now has to work harder.”
Virologist expects more mutations
Hengel, who was also President of the Society for Virology until a year ago, believes that the current situation will lead to more and more variants and mutants. “The virus no longer has the simple situation that nobody is immune. Now the virus really has to show what it can do. So the fittest viruses are selected by weakly effective antibodies. And that is why the mutants will now gain in importance,” says Hengel. That is why the molecular monitoring of coronaviruses is particularly important now.
Health Minister Jens Spahn, has now also issued an ordinance – much too late for many – that is intended to encourage laboratories to sequence coronaviruses with generous reimbursement prices. It is also questionable how the previously approved vaccines react to the new mutations. “I don’t think the vaccines are no longer working,” says virologist Hengel. But he fears that they may become less effective. “I think the current Sars virus will end up as a seasonal corona virus,” says Hengel.
You will always see severe corona infections. But by and large you will get the matter under control – “provided you have effective vaccinations and the vaccines are continuously updated. Similar to influenza.” In any case, the mRNA vaccines are well suited for this because they can be adapted to new mutations relatively quickly and easily.
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