August 25, 2020
A coworker forwarded me an article about researchers in Hong Kong who have clearly defined and documented a single case of re-infection with COVID-19. He asked me if this concerned me and whether it would disrupt hc1’s efforts to prevent and defend against the COVID-19 pandemic. My answer was no.
Re-infection can occur in almost any viral disease:
- The common Epstein-Barr virus (human herpesvirus 4) that causes infectious mononucleosis (“mono”) can reactivate in a person’s body, making them contagious again. In rare cases, the virus can become chronic active Epstein-Barr virus infection.
- The varicella zoster virus that causes chickenpox often reemerges as shingles (herpes zoster).
- A mild case of the measles virus can reoccur in a person who only builds a mild antibody response. We re-immunize children for MMR (mumps, measles, rubella) knowing that antibody resistance may weaken and a secondary case could happen.
Can re-infection of COVID-19 happen? Yes, no surprise. Does it happen often? Likely very rarely with COVID-19. After millions of people have been infected, here is a report of one case in China becoming infected to a second genotype of COVID-19.
Should we plan national policy around this incident? No, we should plan quickly for the 99.999% of times where the first, and only, infection is the dangerous episode of illness in a person. This is also the episode where transmission could occur and become dangerous to others.
Let’s not get distracted by these rare incidents of re-infection. We need to stick to the COVID-19 prevention and mitigation basics:
- Wear a mask whenever in public places out of the home
- Wash hands frequently and thoroughly (20-second rule)
- Keep distanced from others by at least 6 feet
- Isolate yourself immediately if you begin to suffer any of the classic symptoms of COVID-19: fever, shortness of breath, cough, flu-like symptoms, loss of smell
- Get tested for the virus if you have likely been exposed or have symptoms
- Avoid gatherings in small rooms with small air volumes where aerosolized virus droplets can survive longer
- Enhance air exchange and viral filtration devices in rooms where people meet (e.g. classrooms)
What this re-infection case does point out is what was already thought likely. When a reliable and safe vaccine is developed, it will probably require a booster to promote enough of an antibody and T-cell response in the person so long-term immunity is secured. The genotype of COVID-19 will need to be monitored as well so that the vaccine can be adjusted yearly to best match the most prevalent genotype of the virus.
Until then, focusing our resources and energy on the COVID-19 prevention and mitigation basics will protect us from infectious sources; not only from the initially infected, but also from those rare “re-infection” cases.
About the Author
Peter J. Plantes, M.D. has three decades of experience creating service and delivery solutions that enhance marketplace success and clinical performance for clinical practice groups, academic faculty group practices, hospitals, health systems, and health care organizations. His success stems from his ability to blend and synergize clinical knowledge, operational expertise, financial performance, and collaborative methodology with his deep commitment to serve patients and improve the health of the community. Dr. Plantes has served in CEO & Physician Executive roles for a number of large healthcare clinical delivery networks including regional community networks, academic practices, national hospital networks, international health systems (Chile, Colombia), and corporate managed care/HMO networks.