A man in Nevada was infected with Kovid-19 in March. He again tested negative for Kovid-19. In the midst of an epidemic there would have been an anecdotal story of her infecting millions of people in the US – if she had not been infected again after six weeks.
The 25-year-old male from the American Southwest became the one who appears to be the only published case of Kovid-19 reinvestment in the scientific literature, along with the case of reinvestment in Hong Kong.
A long-time home worker in Reno claimed to be at home to a family member when he became ill. Researchers believe that when the family member, also an essential worker, brought home a slightly different coronavirus strain in early June.
“We had an outbreak in a long-term care facility, and they were in a position to work with patients,” said Heather Kervin, Washer County, Nevada’s epidemiology program manager, who worked directly with the case.
The man had to be hospitalized in his second bout with Kovid-19, but eventually recovered. He is still suffering side effects. “They are experiencing some form of fatigue and brain fog effects,” Kervin said.
To a large extent, virologists can be expected to control them. But experts said the US reinvestment case highlights the enduring secrets of coronovirus, which involves protecting a person’s immune system from an virus after an infection and the virus’ interactions with personal biology. Regeneration cases are also important for developing them as the world’s medical community race to assess vaccine development and their impact.
“If we don’t get long periods of protection from natural infections, we probably won’t meet the vaccine,” said Dr. Arnold Monto, professor of epidemiology and public health at the University of Michigan School of Public Health. “Most of our vaccines do no better than natural infections in terms of preservation.”
Two cases alone cannot solve these mysteries. Experts said that scientists would need population-level studies to solve that question. These case studies represent the beginning of that work.
“Whether there is immune control of the virus is an important question and these cases are going to allow us to find it out,” said Dr. infectious disease specialist at the General Hospital of Massachusetts. Rajesh T. Gandhi, Professor of Medicine at Harvard Medical School and chair of the HIV Medicine Association.
More broadly, the Nevada case also reveals the power that can be endured by strong testing, contact tracing, and public health expertise at a time when all three are attacked. Public laboratories and contact tracing programs have reduced funding in the decade since the Great Recession.
According to Kaiser Health News, per capita funding for the state’s health departments has decreased by 16% since 2010. Many are now terrified – dominating the subjects of Kovid-19 outbreaks and suspicion or apparent conspiracy theories. Until some time ago, Kervin led a team of only two other epidemiologists (sometimes “disease detectors”) who were to locate more than 8,000 cases in all of Washoe County.
“We are running 10, 12, 14 hours, seven days a day operations for four to six days a day.”
Washoe County epidemiologists, Nevada Public Health Laboratory and university scientists went to great lengths to confirm the case in Nevada, and even ran “paternity tests” to ensure samples from the same person.
“A laboratory will just have to make an extremely concerted effort to do more,” said Mark Pandori, director of the Nevada State Public Health Laboratory and an associate professor of pathology at the University of Nevada, Reno School of Medicine. Pandori was the co-author of the case study.
Her lab was alerted in the case of one of Kervin’s epidemiologists, who was in contact with the patient. When the patient began reporting Kovid-like symptoms, Kerwin again informed the laboratory.
The laboratory was able to retrieve the initial sample as technicians made a plan to look for anomalies at the onset of the epidemic. He kept more than 100,000 samples, which were filtered from every corner of Nevada except Las Vegas. Those samples included 25-year-old Reno.
When Pandori’s lab found that the man was positive for Kovid-19, bioinformatics analyst Richard Tillett of the University of Nevada Reno was asked to sequence the genome of both old and new samples.
“I started with a vigilante alarm,” Tillett said. He said that he “wanted to make sure it was genuine, and that it could be found by others and that we were not at fault”.
Tillett ran the panel for a second time, then asked Joel Sevinsky of Theigen Consulting LLC to validate the result. Scientists had the same conclusion – the same patient, two different infections.
Tillett reported the results to Pandori, and Pandori sent a Washoe County Sheriff to the man’s home to obtain a DNA sample so the team could ensure they were not two separate people.
“They are both Kovid-19, and they are also both within the major North American strain, but there are snipe-mutations that occurred in the first infection that are not mutated in the second infection,” Tillett said. “And the second infection has its own specific mutations.”
But it can also raise questions. Did Nevada’s lab find a needle in a hystac, or could many more such cases be unknown due to the dreaded public health infrastructure?
Experts said the case helps understand the shortage of public health workers in the US, and how their work can address basic questions about a little understood virus.
Mary Pittman, Chief Executive Officer of the Public Health Initiative, said, “A nationwide interpretation of public health is really my concern.” “This is one of the things we have to identify and rectify, because this is not our last epidemic.”
In late August a case study of the man’s revision was published in Lancet’s pre-print service, or non-peer-reviewed publication. The case is now undergoing peer review for further publication. The first case of reinforcement was published in August by researchers at the University of Hong Kong in the journal Clinical Infectious Diseases.
Like in Hong Kong, researchers in Nevada sequenced the genome of two samples from the same individual, and saw what was different in the genetic code of both infections. The findings point to a grab bag of secrets that has surrounded the coronovirus almost as soon as it was identified.
How long does natural immunity last? How common is critical illness during the second infection? Does individual biology play a role in reinfection?
Gandhi said, “You really need many, many cases to say – people are going to get sick a second time.” “You can’t do it with just one or two cases because you don’t have enough to sink your teeth into.”
Crucially, a 33-year-old man, a Hong Kong patient, was recalibrated but asymptomatic on his second infection. In Reno, the 25-year-old had worse outcomes, was hypoxic, and briefly hospitalized.
The CDC is beginning to run longitudinal studies, Monto said, and so is the University of Michigan, with 300 home programs originally designed to assess influenza vaccines.
“If you have to work hard to confirm this to me, it says that it hasn’t happened very often,” he said. “But, and here’s the caveat, we don’t have a lot of time because people got infected to see it first.”