The woman, who suffered from a rare white blood cell cancer known as Waldenström’s macroglobulinemia and being treated with B-cell-depleting therapy, arrived at the emergency room with fever and a severe cough and was confirmed as infected with the virus. She was discharged after five days and her symptoms subsided except for some persisting fatigue.
Some 59 days after the start of the first coronavirus episode and two days after a new chemotherapy treatment, the patient developed fever, a cough and shortness of breath. She tested positive for coronavirus, but antibody tests showed that she had no antibodies against the virus. The woman died two weeks later.
The researchers found that the viruses in the two instances of infection were different strains. They explained that while there was no test taken between the two episodes to confirm if the patient was negative in between, the mutation rate of the virus indicates that the second episode was a reinfection.
The case report referenced a case in Nevada in which a 25-year-old patient with no underlying conditions had a more severe case of COVID-19 after he was reinfected. The Dutch patient, in contrast, was immunocompromised, but the researchers believe that even with the B-cell-depleting treatment she was receiving, she still could have technically recovered from the virus without experiencing a life-threatening disease.The Nevada case was the subject of a study published in the journal Lancet. The patient also had two genetically distinct strains of the coronavirus, similar to the Dutch patient."Previous exposure to SARS-CoV-2 might not guarantee total immunity in all cases. All individuals, whether previously diagnosed with COVID-19 or not, should take identical precautions to avoid infection with SARS-CoV-2. The implications of reinfections could be relevant for vaccine development and application," wrote the researchers.
IT REMAINS unclear how long immunity lasts with the novel coronavirus and how common reinfection is, as cases of reinfection have been reported around the world. A recent study in Iceland showed that antibodies to the novel coronavirus didn't decline within four months of infection, but a Hong Kong resident who was one of the first people confirmed as reinfected had no measurable antibodies at the start of the second infection which happened about four to five months after the first.The case report pointed to seasonal coronaviruses, saying that reinfections happened within as early as six months, and indicating that the novel coronavirus may behave similarly.
The Dutch patient and the patient in Nevada were both reinfected within two months.
Some Israelis who seemingly recovered from COVID-19 and then fell sick with symptoms a second time told Channel 12 in September that the second round was more difficult.
Prof. Arnon Ofek, deputy director-general of Sheba Medical Center, told Channel 12 that while this kind of situation is relatively rare, it is showing up in literature around the world.
"The first case was in Hong Kong, but there were also cases in Nevada and other places. Some of the cases were lighter but some were more severe."
"We don't really know everything about the virus and it will still surprise us in many things. In the end, immunity is created but it is different between people. We believe that there is a degree of protection," said Ofek. "This also has importance regarding the vaccine: We know that people will need two doses and that we will have to vaccinate again in X [amount of] time."
CASES OF suspected reinfection with the novel coronavirus have been reported multiple times in Israel.
In June, a doctor at Sheba Medical Center in Tel Hashomer tested positive again for the novel coronavirus three months after initially recovering from the disease.
The doctor suffered from fever, cough and muscle pain when she tested positive for the virus in April, but she recovered and tested negative in May and June, before coming into contact with a confirmed patient and testing positive again.
The doctor “tested positive again because she has remnants of her first virus still floating around in her body,” a hospital spokesperson told The Jerusalem Post at the time.
In May, a 45-year-old woman from Jisr e-Zarka tested positive for coronavirus after being readmitted to Hillel Yaffe Medical Center in Hadera, suffering from fever and chest pains. This came a month after she was discharged after recovering from the virus and testing negative twice.
Preliminary studies in China, Germany, the UK and elsewhere have found that patients infected with the novel coronavirus make protective antibodies as part of their immune system’s defenses, but these appear to last only a few months.
Some experts say it is likely that such cases are starting to emerge because of greater testing worldwide, rather than because the virus may be spreading differently.
Still, Dr. David Strain, a clinical senior lecturer at the University of Exeter and chairman of the British Medical Association's medical academic staff committee, said the cases were worrying for several reasons.
"The first is that it suggests that previous infection is not protective," he said. "The second is that it raises the possibility that vaccinations may not provide the hope that we have been waiting for."
To be truly effective, COVID-19 vaccines “will either need to generate stronger and longer-lasting protection... or they may need to be given regularly,” said Stephen Griffin, a Leeds University associate professor of medicine. “And those things are not trivial.”
Celia Jean and Reuters contributed to this report.