- 27-year-old woman from Bengaluru had tested positive for COVID-19 in July
- After recovery the woman again reported symptoms of COVID-19, in August
- Test shows she had no antibodies against COVID-19 to develop an immunity
New Delhi: In the first week of July, a 27-year-old woman from Bengaluru developed fever and cough following which she tested positive for Novel Coronavirus. The woman had a mild infection and recovered soon without any complications. After testing negative for COVID-19 disease the woman was successfully discharged from the hospital. However, after one month of recovery, in the last week of August, the woman again contracted SARS-CoV-2 and tested positive for COVID-19. The case from Fortis Hospital on Bannerghatta Road is reportedly the first incidence of coronavirus reinfection in Bengaluru.
Explaining the case of reinfection , Dr Pratik Patil an Infectious Diseases Consultant at Fortis Hospital’s Bannerghatta Road facility said,
Immunoglobulin G (IgG) antibodies usually represents the immune response and test comes positive after 2-3 weeks of infection showing that the patient has developed COVID-fighting cells. However, in this patient, the antibody test has come out negative, which means she did not develop immunity following the first infection. The other possibility is that the antibodies disappeared within the months’ time, leaving her susceptible to reinfection.
Dr Patil also suggested that it may be possible that some patients don’t develop antibodies at all. However, there is not much literature about it but the development of antibodies varies from individual to individual.
Talking about the possibility of reinfections Dr Ravindra M. Mehta, Chief of Pulmonary and Critical Care Medicine at Apollo Hospitals, Bengaluru, suggested understanding that whether it is actually a case of reinfection or a suggestion of reinfection. He said,
In Hong Kong, coronavirus reinfection was confirmed only after a genomic study which showed that reinfection happened with a second strain of virus. That is something we have not done in this case.
Elaborating on immunity and what can lead to reinfections, Dr Mehta added,
The possible reasons are, say, you got an infection but your immune system didn’t produce a response or enough response to have lasting immunity. A decay of immunity is a known case. Secondly, we cannot measure immunity. We have an antibody test but it a qualitative test and not a quantitative test so we don’t know how much antibodies have been developed by an individual and how many are required. Thirdly, the reinfection has been concluded based on a test. Low level of viral shedding goes on for weeks. Therefore, based on this case, we cannot assume that all of us with low antibodies or low immune response will get reinfected.
Dr Mehta also noted that patients reporting developing infection for the second time have mild symptoms only. Patients of coronavirus reinfections are not developing severe disease.
Contrary to this, Dr Patil said that currently, we don’t have enough information to state that the second round of infection will unifromly be weaker than the first one. He said,
This particular patient had a mild infection. In some cases of viral infection, the second infection is milder but in some, like dengue, the reinfection tends to be severe if you have had dengue once.
The reinfection is a matter of concern especially when India has started to report over 90,000 fresh COVID-19 cases and is now the second worst-hit country in the world. It also raises a question about the duration for which a vaccine would remain effective. According to Dr Mehta, this may not have a bearing on vaccine development.
Talking about immune response and vaccine, Dr Patil said,
Not everybody who takes vaccine will develop an immune response. In the case of influenza, the vaccine gives protection IN 60 per cent of the cases. 30-40 per cent of cases do not develop antibodies. We will have to see the efficacy of the COVID-19 vaccine and the immunity it provides.
According to Dr Jayaprakash Muliyil, Ex. Principal, CMC Vellore and Leading Epidemiologist, there may not be a need for a different vaccine for the modified strain of virus causing reinfections because those viruses may not be too different in genetic sequence from the original virus. Having said that, Dr Muliyil emphasised on more evidence and information.
COVID-19 Reinfections Across The World
Earlier in August, researchers from the Hong Kong University revealed the first confirmed case of COVID-19 reinfection after a 33-year-old IT (Information Technology) worker who contracted the coronavirus in March this year and was cleared of Covid-19 and discharged from a hospital in April, tested positive for the virus again after returning from Spain in August. The findings also show that the viral strain in the reinfection is genetically varied from the virus contracted by him earlier.
A day after the case of Coronavirus reinfection from Hong Kong came to notice, the Health Minister of Telangana announced that at least two cases of reinfection have taken place in the state.
Two patients in Europe have also been confirmed to have been re-infected with COVID-19.
Dr Muliyil said that reinfection is expected but rare and added,
For example, there is a 24 per cent chance that an adult who is fully vaccinated with poliovirus can establish the virus temporarily if given the poliovirus. But in the case of coronavirus, the human body is not easily permitting reinfections.
In a media briefing on September 7, while responding to journalists, the World Health Organisation (WHO) also addressed the issue of coronavirus reinfection. Talking about the behaviour of the virus in the case of reinfections, Dr Maria Van Kerkhove, Technical Lead COVID-19, WHO Health Emergencies Programme, informed that a number of studies are underway that are following individuals – the same individual over time and said,
The studies are looking at how strong that antibody response is depending on the type of disease you experience – whether you have asymptomatic infection, mild disease or all the way severe disease. We are seeing that people even with the asymptomatic infection still develop an immune response. What we need to understand how strong that is and for long it lasts.
Dr Maria noted that there are some very promising results from these studies showing that the antibody response lasts, it stays strong for a certain number of months. She added,
We are only eight months into this pandemic and we have not followed individuals for many, many months so we don’t know how long that robust immune response lasts.
Dr Maria also spoke about cases of coronavirus reinfections from Hong Kong and the United States that were confirmed by full genome sequencing and in those cases, health experts are trying to understand the immune response. She said,
We are looking at what type of immune response did they have on their first infection, if that was even measured and then at the time of the second infection, did they have measurable antibodies. In some individuals, the immune response may decline. But again, out of more than 26 million cases having some case reports of reinfection tells us that this is possible but it doesn’t tell us what’s happening at a population level.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.