A 25-year-old child may have contracted the Covid-19 coronavirus twice with a worse reinfection

Throughout this beeping pandemic, a key question has been whether you can get the Covid-19 coronavirus more than once. Well, last week, several different reports seemed to kick the “can.” And now there’s a report of a 25-year-old man in Reno, Nevada getting reinfected adding to the can-can dance. Oh by the way, the news was worse the second time around.

Before we get to the Reno case, let’s recap what happened during the last seven days. The week began with the news that a 33-year-old man from Hong Kong was reinfected. As Sarah Hansen covered Forbes On August 24, this man had first experienced mild symptoms of Covid-19 in March, tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), and then four and a half months later, tested positive again for SARS -CoV2. The second time he had no symptoms, but genetic sequencing revealed that the virus was a different version of SARS-CoV2. This suggested that he had had two separate infections, which is not great news unless you are the virus or are betting on the virus.

What made this case different from previous reports of possible reinfection was the genetic evidence that the viruses in the man’s two episodes of the man’s Covid-19 coronavirus infection were different. Researchers at the University of Hong Kong have yet to formally publish the case report in a peer-reviewed journal (although it is apparently a preprint of the journal Clinical infectious diseases) or disclosed all data. So everyone has had to take the Hong Kong finds with a can of salt.

Here’s a TODAY show report on that case:

Then on August 25, Carlie Porterfield showed up for Forbes in at least two, possibly three, more reported reinfection cases in Belgium and the Netherlands. Since this was news, it was more cans of salt. However, this meant perhaps, perhaps, potentially more cans to fill the evidence closet.

As they said in the tv series Teen wolf, one is an accident, two is a coincidence, three is a pattern, and four is enough for a court order. How much is five? Well, there are more than four and it rhymes with hive, as this raises a hive of questions when it comes to developing a Covid-19 vaccine and controlling the pandemic.

A prepress for The lancet details the latest in can-can dancing. Again, a preprint is not the same as a peer-reviewed scientific journal article. The case report has yet to pass the eyes of the relevant experts, who will criticize the report. Someone showing you a prepress would be like someone showing you a script for Avengers: Endgame, The Musical. There’s no guarantee you’ll see Thanos and Thor singing “Should Have Gone for the Head” in duet anytime soon, and there’s no guarantee that a preprint will hit the jackpot and end up getting published. However, if this case report were to make it formally to the pages of The lancet, it would be the first documented case of reinfection in the United States.

Written by a team from the University of Nevada School of Medicine, Reno, the Nevada Center for Bioinformatics, the Nevada State Public Health Laboratory, and another organization, the case report offered some pretty compelling evidence. He described a saga that began on March 25, 2020, when the Reno, Nevada resident began having symptoms of a viral illness. Ultimately, these symptoms included a sore throat, cough, headache, nausea, and diarrhea. Of course, normally, diarrhea in Reno could mean many different things. However, today, you have to wonder if you have Covid-19. In fact, a test for SARS-CoV-2 on April 18 came back positive, not in a good way, but positive for the virus. That meant he had to isolate himself. His symptoms finally resolved on April 27.

That appeared to be the end of his first Covid-19 case, as he had two subsequent negative tests for SARS-CoV-2 RNA on May 9 and 26. Everything looked like peach (which means “fine” and not in a Salmonella contaminated route) until May 28, when he again had symptoms such as fever, headache, dizziness, cough, nausea and diarrhea. This prompted another visit to the doctor on May 31. There they did a chest X-ray, which came back negative, before returning home. The SARS-CoV2 test wasn’t repeated because at the time, if you played the odds in Reno, reinfection didn’t seem likely.

Things got worse on June 5, when worsening symptoms convinced him to visit his GP. The doctor found that the patient’s blood oxygen levels were too low and sent him to the emergency department (ED). In the emergency department, doctors administered oxygen, tested him for SARS-CoV2, and admitted him to hospital. A repeat chest X-ray showed that, in the meantime, he had developed new patches of material in both lungs. Of course, things are not a medical term. As long as your doctor tells you that you have stuff and nonsense on the chest X-ray, it’s usually not a good sign, but ask for more clarification. In this case, it was “bilateral interstitial opacities”, findings highly suggestive of pneumonia. And lo and behold, the SARS-CoV2 test came back positive. The next day, June 6, a blood test for antibodies (IgG / IgM) against SARS-CoV-2 also came back positive.

So basically a pretty young guy had a Covid-19 episode, recovered, and then 48 days later, he had what appeared to be a separate second Covid-19 episode. Was it just a prolonged infection? In other words, the second episode was like a later part of the movie. Deuce Bigalow: Male Gigolo or was it like Deuce Bigalow: European gigolo, A worse sequel separate from a bad original? Nucleic acid sequencing of the virus samples from the two different Covid-19 episodes revealed significant differences in their genomes. Essentially, the virus from the previous infection had different mutations at different locations on the virus from the second infection.

This tweet from Akiko Iwasaki, PhD, Waldemar Von Zedtwitz Professor of Immunobiology and Molecular, Cellular, and Developmental Biology at Yale School of Medicine, shows her thoughts on the genetic sequencing findings:

The Reno team conducted different tests to confirm that these findings were not due to the software used or the mishandling or incorrect labeling of the samples. Also, it is noteworthy that the patient’s immune system appeared normal. He was not taking any medications and did not have any medical conditions that could suppress his immune system.

A key difference with this case compared to the Hong Kong and Belgium cases is that the man in Nevada suffered an apparently worse episode of Covid-19 the second time. This suggested that his immune response from the first time did not really protect him. Could the immune response to the first infection have increased the impact of the second infection? Empowering means increasing the power of, as that avocado slice boosted my ability to get past Zoom’s 10th call of the day.

For some infections and diseases like dengue, after being infected once with one strain of the virus, you may actually have a worse illness when later infected with another strain of the virus. Although the reasons for this are not entirely clear yet, one theory is that your immune system recognizes the second strain but not well enough to respond effectively and may overreact as a result. This could be similar to a person having a bad relationship, mistrusting relationships as a result, entering a second relationship, and then overreacting to everything during the second relationship due to increased suspicion.

Still, there is growing evidence that reinfection with the Covid-19 coronavirus is possible. However, don’t press the panic button just yet. In general, if you see a button labeled “Panic”, do not press it. Also, some cases do not necessarily mean that reinfection is common. As you may find in Reno casinos, reports of rare events do not mean it will happen to you. The odds are important and it is not yet clear how often a reinfection can occur. As I wrote earlier for Forbes, more studies are needed to determine if there is immunity against the Covid-19 coronavirus and how long it can last. It is also unclear whether natural infection would be different from vaccination and whether vaccination would offer different levels and types of protection. Even if reinfection can occur, researchers must determine how frequent it can be. After all, just because you can, doesn’t mean you will.