A man from Hong Kong who had a confirmed bout of COVID-19 in April and made a full recovery was reinfected more than four months later after travelling overseas.
The pre-print study, by a team at the University of Hong Kong, claims to be “the world’s first documentation” of a patient who recovered from COVID-19 becoming reinfected. Researchers sequenced the genome of his first and second infections to show the virus strains were different, illustrating that he had been reinfected.
The study and findings, which have not been peer-reviewed, were released on Monday and have potential implications for vaccine use, as well as policies based around the concept of herd immunity that presume those who recover from the virus are unlikely to be reinfected.
The man, an unnamed 33-year-old IT worker with a reported history of good health, had no symptoms when he contracted COVID-19 the second time, which indicates the man’s immune system protected him from the disease, although it did not stop the reinfection.
Study author and renowned microbiologist, physician and surgeon Kwok-Yung Yuen and his colleagues state in their paper that herd immunity is unlikely to eliminate COVID-19 on its own and that a potential COVID-19 vaccine may not provide lifelong immunity to the disease.
“This is a textbook example of how immunity should work,” Professor Akiko Iwasaki, an immunology expert at Yale University, tweeted on Monday, referring to the man’s lack of symptoms.
Iwasaki also said the research had “no bearing” on the success of a potential coronavirus vaccine.
“Vaccines can provoke a much higher level of immunity in a person that can potentially block reinfection, or at least shut it down to a non-contagious level,” she wrote in response to a reporter’s questions.
A first case of #COVID19 reinfection from HKU, with distinct virus genome sequences in 1st and 2nd infection (142 days apart). Kudos to the scientists for this study.
This is no cause for alarm – this is a textbook example of how immunity should work.
— Prof. Akiko Iwasaki (@VirusesImmunity) August 24, 2020
The study was accepted by the journal Clinical Infectious Diseases on Monday and it is likely to be published online within the next day, said Lili Kadets, a Clinical Infectious Diseases spokeswoman. It was “reviewed and accepted” by Robert T. Schooley, an infectious-diseases expert at the University of California at San Diego, and the journal’s editor in chief in what Kadets called a “rapid review process” used for some COVID-19 studies due to their time-sensitive nature.
The Hong Kong man whose case was studied, an unnamed 33-year-old IT worker with a reported history of good health, had first tested positive for COVID-19 in late March. His symptoms included a fever and a cough and he was sent to the hospital in keeping with city health regulations.
The man was released in mid-April after testing negative for the virus and having no further symptoms. But after visiting Spain via Britain in August, he tested positive again upon returning to Hong Kong, despite appearing asymptomatic.
Physicians at first thought he might be a persistent carrier of the virus, the study’s authors write, but they sequenced the genome of his first and second infections to show the virus strains were different, indicating he had been reinfected.
The man’s reinfection may suggest the level of immunity after an infection may be lower than many had hoped, or may decline over time, or may occur on a spectrum, for instance, offering partial immune protection.
The paper described that while the patient had no detectable antibodies at the time of the second infection, he developed them afterwards — a sign Iwasaki called “encouraging”.
Studies that look at antibodies after a case of COVID-19 have reached differing conclusions about the level of immunity that can be expected months later. Experts have noted with the common cold, another illness caused by a coronavirus, people are often reinfected each season.
“What we are learning from this new case report is that SARS-CoV-2 may persist in the global population, similar to other common cold-associated human coronaviruses, even if patients have some degree of acquired immunity,” Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City told the Washington Post.
“The only safe and practical approach to achieve herd immunity is through vaccination,” he said, although even immunisations might not provide lifelong protection.
Glatter said that more studies are needed to “evaluate the spectrum of illness — and degree of immunity achieved — as a result of reinfection” by the virus. It will be key to figure out how widespread reinfection might be and whether subsequent infections carry as many risks as the first infection.
“The take home is that a vaccine, no matter how novel or sophisticated, may not be able to provide lifelong immunity against COVID-19. This is in keeping with other seasonal coronaviruses,” he said, adding that it may be possible that vaccines have to be administered twice a year to supplement natural immunity.
The highest number of deaths from confirmed cases of COVID-19 on Monday was in India (854), followed by Brazil (679) the US (490), Argentina (381) and Colombia (296), which represents 63% of all reported fatalities caused by COVID-19 on Monday.