Covid-19 CAN strike twice: 33-year-old man in Hong Kong is the first person to get reinfected - Daily Mail

Covid-19 CAN strike twice: 33-year-old man in Hong Kong is the first person to get reinfected after testing positive for a mutated strain of the virus four months after recovering

• Genetic analysis revealed the second infection was caused by a different strain  
• The patient had returned from Spain to his home of Hong Kong
• Doctors warned 're-infection can occur just a few months after recovery'
• They said immunity may be short lived and antibodies wane over time 

By Vanessa Chalmers Health Reporter For Mailonline

Published: 14:54 BST, 24 August 2020 | Updated: 16:46 BST, 24 August 2020

Covid-19 survivors can get reinfected, according to doctors in Hong Kong who have reported the first accepted case of someone being struck down twice.

The 33-year-old man — who had no known underlying conditions — tested positive for the coronavirus four months after recovering from the infection.

Genetic analysis revealed the second infection, which he caught on a trip to Europe, was caused by a different strain of the virus than that which triggered his first bout of the disease.

All viruses — including SARS-CoV-2 — mutate as they spread around the globe. The changes to pathogens, which can make them weaker or deadlier over time, can be detected by analysing their DNA.

Doctors warned their findings prove 're-infection can occur just a few months after recovery'. They said it was likely immunity is short-lived and that antibodies against Covid-19 fade quickly.

But the unidentified man did not have symptoms of Covid-19 the second time — he was only discovered through screening at an airport. This may suggest he had some level of immunity that protected him from severe disease.

Covid-19 survivors can be reinfected twice, according to doctors in Hong Kong who report the first known case

Hopes of long-lasting immunity have been hampered by several reports that have claimed to prove people can be struck down with the coronavirus twice.

But until now, scientists have reiterated that cases of re-infection were more likely down to a fault with testing, or that inactive particles of the virus are still present in the body of patients months after they beat the illness.

With some illnesses such as chickenpox, the body can remember exactly how to destroy it and becomes able to fend it off before symptoms start if it gets back into the body.

Experts say Covid-19 reinfections would hinder global efforts to contain the infection because it suggests that patients are not protected for a long time, leaving countries at risk of another wave this winter.  

But academics said this one singular report — which will be published in a medical journal — does not prove they occur. 

Researchers from the Li Ka Shing Faculty of Medicine at the University of Hong Kong say they are the first to prove a second re-infection of the coronavirus.

And they insisted the finding does not mean taking vaccines will be useless. Dr Kai-Wang To, study co-author, said: 'Immunity induced by vaccination can be different from those induced by natural infection.

'[We] will need to wait for the results of the vaccine trials to see if how effective vaccines are.'

In a press release, they described how an 'apparently young and healthy patient had a second episode of Covid-19 infection'.

The man, of Hong Kong, was first diagnosed on March 26 after having a cough, sore throat, fever and headache, according to parts of the paper revealed by a journalist at the South China Morning Post.

He was hospitalised that day but all his symptoms subsided after three days. He was discharged on April 14 after two negative test results.

In his second episode, the man was tested on August 15 when he returned to Hong Kong from Spain via the UK. 

He was hospitalised again but did not have any symptoms. It's unclear why he was hospitalised but it may have been due to his rare circumstances.

The researchers, led by Dr Kelvin Kai-Wang To, took samples of his saliva both times he tested positive and analysed the genetic sequence of the strain. 

The process allows experts to identify what mutations coronavirus had accumulated over time.

These genetic variants can act as the fingerprints of the pathogen, to indicate where in the world it originated. 

The press release said: 'The team showed the genome sequence of the virus strain in the first episode of Covid-19 infection is clearly different from the genome sequence of the virus strain found during the second episode of infection.'

The first sample he had taken is most likely related to strains from the US or England collected in March and April, the academics claimed.

While the second — which was different in 24 places — was most similar to samples found circulating in Switzerland and England between July and August.

The press release revealing the first known case of re-infection with Covid-19

ARE THERE DIFFERENT STRAINS OF COVID-19? 

Scientists have discovered various strains of the coronavirus by looking at its genetic mutations. 

Viruses mutate naturally all the time and it is not usually cause for alarm but should be studied in case they change so much they become unrecognisable to the body and immunity from a first infection cannot protect against them, as is the case with flu.

A study done by scientists at the University of Sheffield and Los Alamos National Laboratory, New Mexico, found that the original virus made up the vast majority of all Covid-19 infections in China, and Asia as a whole, and also seemed to be the first version of the virus to appear in the countries they studied.

However, the mutated version started to appear soon after in Europe and North America in particular, before going on to take over as the dominant virus. 

Paul Tambyah, senior consultant at the National University of Singapore and president-elect of the International Society of Infectious Diseases, believes a strain of the coronavirus thriving in Europe, the US and parts of Asia has a specific mutation which makes the virus more infectious but less deadly.

The variation in the SARS-CoV-2 virus, the agent which causes Covid-19, is called D614G.

Dr Tambyah said evidence suggests the proliferation of the D614G mutation in some parts of the world has coincided with a drop in death rates, suggesting it is less lethal.

'Maybe that's a good thing to have a virus that is more infectious but less deadly,' Dr Tambyah told Reuters.

Dr Tambyah said most viruses tend to become less virulent as they mutate. 

'It is in the virus' interest to infect more people but not to kill them because a virus depends on the host for food and for shelter,' he said.

Scientists discovered the mutation as early as February and it has circulated in Europe and the Americas, the World Health Organization said. 

The WHO has also said there is no evidence the mutation has led to more severe disease.

Previous research by scientists at The Scripps Research Institute in Florida offers a potential explanation for the virus's altering traits. 

They found the mutated version D614G has four to five times more 'spikes' that protrude from the viral surface, allowing it to latch onto human cells.  

These so-called S spikes are crucial in how the virus invades a cell. They trick receptors called ACE2 on the surface of human cells into binding with the virus.

This opens the door for the coronavirus to infect the cell where it thrives, multiplies and wreaks havoc. 

However, the original coronavirus which first jumped into humans had a spike which often snapped off when trying to fuse with the receptor. 

The mutated strain, they say, is more robust and less likely to snap, making it better at infecting cells. 

Although the mutation makes the virus better at infecting cells, it does not appear to make it any more potent or deadly. 

Researchers in the UK and US had in May noted that the mutated version of the virus had become 'the dominant pandemic form in many countries', including the then- hotspots of Italy, the US and the UK. 

They said it was first found in Germany in February and had since become the most common form of the virus in patients worldwide - it appears to force out the older version whenever they clash.

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'This case illustrates that re-infection can occur after just a few months of recovery from the first infection,' the researchers said.

'Our findings suggest that SARS-CoV-2 may persist in the global human population as it is the case for other common-cold associated human coronaviruses.'

The underlying reasons why the man got Covid-19 again are not clear. It may simply because his immune system had already forgotten the coronavirus entirely, suggesting short-lived immunity. 

On the other hand, his lack of symptoms may suggest his immune system did recognise the coronavirus and was primed to attack, regardless of what strain it was.  

Commenting on statements made by HKU, independent scientists admitted it is the strongest evidence of re-infection yet because it used genetic sequencing.  

Dr Jeffrey Barrett, of the Wellcome Sanger Institute, said: 'This is certainly stronger evidence of re-infection than some of the previous reports because it uses the genome sequence of the virus to separate the two infections.

'It seems much more likely that this patient has two distinct infections than a single infection followed by a relapse (due to the number of genetic differences between the two sequences).'

However, he said it was very hard to draw conclusions without a full report. 

Dr Barrett said: 'It may be that second infections, when they do occur, are not serious (though we don’t know whether this person was infectious during their second episode).'

He added that given the number of global infections to date — 23.5million — one case of reinfection 'is not surprising even if it is a very rare occurrence'. 

Dr Simon Clarke, an expert in cellular microbiology at the University of Reading, said: 'The significant thing here is that being re-infected with a mutated strain demonstrates that it is more likely to be re-infection, rather than the same infection that has hung around because the virus has not actually been got rid of, as some people have suggested happens.'

He added that mutant strains are 'nothing to be shocked or surprised about'.

Until now, it was unclear if people can catch SARS-CoV-2 twice for a number of reasons.

It's not clear how long immunity to the virus lasts — whether it be a few months or several years — and how this differs between people. 

Common cold coronaviruses are known to cause reinfections in less than a year, with cases spiking in the winter.

But experts had hoped that the new coronavirus might behave more like SARS and MERS, also human coronaviruses, which seemed to produce longer-lasting immunity.

Scientists have found SARS patients still have crucial disease-fighting cells 17 years after infection.

Evidence is beginning to suggest that antibodies disappear in as little as eight weeks after infection with SARS-Cov-2. On the other hand, T cells - which target and destroy cells already infected with the virus - are 'durable'.

Science is still trying to answer questions about immunity, but it's been challenging because the coronavirus has only been known to academics for eight months.  

There have been previous alarms about second Covid-19 infections in the past. But they were not solid in their evidence.

In April, South Korean officials feared a group of almost 300 people had been reinfected after the country saw the virus fizzle out. 

But later, a senior South Korean official, Oh Myoung-don, who leads The Central Clinical Committee for Emerging Disease Control, said the flurry of cases were due to a testing fault - and not a short-lived immunity. 

The infectious disease expert revealed dead virus fragments can remain in the body, possibly for months.

These lingering fragments may cause a positive result, even though the person is not sick or infectious anymore, health chiefs added.  

A Japanese man in his 70s tested positive for coronavirus a second time, in March, after initially being infected while on board the disease-ridden Diamond Princess cruise ship in February.

He tested positive two weeks after he recovered and tested negative. It is not clear how many times he had a negative result. 

It may be possible someone can test positive for longer than two weeks as their body tries to clear the virus, and the negative result was false.

A Japanese woman was also diagnosed again two weeks after her recovery. 

The woman, working as a tour bus guide in Wuhan, where the disease first emerged in December 2019, tested positive on February 26 after a negative result on February 6.

The details are sparse, but the woman had reportedly suffered no symptoms for at least a week between the two episodes. 

Academics said it was a 'concern', but there was too little information to draw conclusions.      

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2020-08-24 13:54:43Z
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