Can you get re-infected with the Covid-19 coronavirus? Can you get Covid-19 again? Are you immune to the Covid-19 coronavirus after you've recovered from an infection? What caused this hole in my underwear?
These are some of the big, big questions that you may have been asking in 2020. After all, the answers to such questions can determine a lot of things such as how cautious you need to be and whether you should buy the same brand of underwear again.
There is increasing evidence that the answers to these questions are "yes", "yes", "not necessarily", and "there are many possibilities." Back in July, I covered for Forbes how a team of researchers infected a group of macaques with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), waited for them to recover, and then were able re-infect the macaques again with the virus.
Of course, as I mentioned back then, macaques are not exactly the same as humans. For example, not all humans tend to expose their genitals when threatened, and macaques don't typically post what they are eating on Instagram. But since that study came out, more and more case reports of Covid-19 coronavirus re-infections in humans have emerged, such as the ones that I described for Forbes in August .
In fact, there have now been enough such case reports for BNO News to maintain a " Covid-19 reinfection tracker ." This is a sign that the evidence for re-infection continues to grow. Usually, an event needs to occur more than just a few times to merit a tracker. That's why you probably don't maintain a "times I ended up in the ER after accidentally punching myself in the face while adjusting my clothes" tracker or "number of times a wombat beat me in chess" tracker. The BNO News tracker includes a list of the confirmed Covid-19 coronavirus re-infection cases that, according to the website, is updated on a daily basis.
Keep in mind that BNO is not an established scientific organization and is not the name of the lead singer for U2 with a typo. Instead, it stands for BreakingNewsOn , a news wire service based in the Netherlands that was launched in 2010 by a company founded in 2007. So technically BNO News is BreakingNewsOn News, and they are collating what they can find in scientific journals, media reports, and other sources. So if you would like to further verify the details of a given specific case, you would have to refer to the sources provided by the tracker.
Currently, the BNO list includes 28 different cases, along with the date that the case was reported, the country location of the case, the age and sex of the person, the number of days between the first infection and the second, the severity of the Covid-19 coronavirus infection in both incidences, an indication of whether the person eventually recovered, and the source that reported the case. Symptoms were present in about 83% of the first infections and 87% of the second infections. On average the second infection came 78 days after the first infection.
In five of these cases, the second infection resulted in more severe Covid-19 than the initial infection. For example, a letter published in the journal Clinical Infectious Diseases described the case of a 42-year-old previously healthy male who saw a doctor on March 21 after experiencing a cough, fevers, and muscle aches and tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). His symptoms resolved 10 days later, and he remained healthy for the subsequent 51 days. But then came the sequel. He returned to he returned with significantly worse symptoms: fevers, cough, shortness of breath, and gastrointestinal symptoms. This time a chest X-ray found a pulmonary infiltrate, which is medical speak for junk in the lung. Junk in the trunk is one thing. Junk in the lung is something quite different and rarely a good thing. Testing revealed that he was once again positive for SARS-CoV2.
There was also one death. Another letter published in Clinical Infectious Diseases detailed how a 89-year-old Dutch woman, who was also suffering from Waldenström macroglobulinemia and receiving chemotherapy, developed a severe Covid-19 coronavirus infection 54 days after recovering from a moderate one. Unfortunately, she did not survive this second infection.
BNO also maintains a web page entitled " Suspected cases of COVID-19 reinfection ." This web page has a list of, surprise, surprise, suspected cases of Covid-19 coronavirus reinfections. As of today, this list includes 1,673 cases and 20 deaths. Over 700 of these cases have been from the U.S. and over 300 from Brazil. Of course, "suspected" simply means suspected and not confirmed. Suspecting that someone sings Britney Spears' "Baby One More Time" while in the shower is not the same as confirming it. To confirm it, you would actually have to hear the words, "Hit me, baby, one more time," and rule out the possibility that the person is asking for another serving of latkes in the shower. Similarly, confirming that a suspected re-infection case requires evidence that a subsequent positive SARS-CoV2 test (after one has recovered from a previous Covid-19 coronavirus infection) did indeed represent a new infection and wasn't just the result of lingering first infection, an error in the testing, or fragments of the virus (versus live virus).
As the following tweet indicates, in many situations, additional testing is necessary to move a re-infection case from being suspected to confirmed:
It's still not clear what percentage of all Covid-19 coronavirus reinfection cases are being captured by the BNO News website or how common reinfection may be. There are probably a fair amount of re-infections not being noticed. It is also not known whether re-infection is more likely for certain groups of people such as those with a more mild first infection or those who are older or younger. The 28 confirmed cases span the age spectrum from six to 89 years old and includes 10 cases of people in their 20s.
For some reinfection cases, perhaps the immune system didn't generate enough of a response. Alternatively, the generated immune response from the first infection may wane over time. As I reported for Forbes in July, a study did suggest that antibody levels in the blood may begin dropping just two months after a Covid-19 infection. But, no one knows for sure yet how long immunity may last in humans and how this may differ from person to person.
What does the re-infection possibility mean for the Covid-19 vaccines? Well, natural infection may not necessarily be the same as vaccination. For example, two doses of a vaccine may generate a more sustainable immune response with the first dose "priming" the immune system, essentially telling the immune system, "hey, here's something that you should respond to," and a second dose "boosting" the response by reminding the immune system, "hey, remember this? Keep on the lookout for it."
So even if you've recovered from having Covid-19, don't assume that you can't get the infection again. Don't assume that the infection will be less severe the second time round. Don't assume that it won't be worse. And for Pete's sake and everyone else's, don't tweet out that you are immune to the virus. There could be many holes in that assumption.
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