In the ensuing weeks, she jumped back to a full recovery. She even took another negative test to participate in the study as one of the earliest donors of recovery plasma in an effort to help others.
Six months later, in September, Romoser fell ill again, after a trip with her father to Florida. This second battle was much worse. She lost her sense of taste and smell and developed persistent headaches and fatigue. She again tested positive for COVID – with her cat.
Romoser believes that this was a clear case of reinfection, rather than that the original infection had become dormant. Because the coronavirus, like other viruses, frequently mutates as it multiplies and spreads through a community, a new infection would have a different genetic fingerprint. But because no laboratory rescued her test samples for genetic sequencing, there was no way to confirm her suspicion.
“It would be nice to have a proof,” Romoser said. “I was literally called a liar because people do not want to believe that it is possible to be infected again. Why would I lie about being sick? ”
As millions of Americans struggle to recover from COVID and encounter millions more for the protection that vaccines provide, U.S. health officials can overlook a disturbing subgroup of survivors: those who become infected more than once. Identifying how common re-infection is among people who have contracted COVID, as well as how quickly it becomes vulnerable and why it has important implications for our understanding of immunity and the country’s efforts to set up an effective vaccination program.
Scientists have confirmed that reinfections after the initial disease caused by the SARS-CoV-2 virus are possible, but so far they have characterized it as rare. According to a global re-infection track, fewer than 50 cases have been confirmed worldwide. Only five were substantiated in the U.S., including two that were found in California in late January.
It sounds like a pretty insignificant number. But scientists’ understanding of reinfection is limited by the limited number of U.S. laboratories that retain COVID test samples or perform genetic sequencing. A KHN review of surveillance efforts finds that many U.S. states do not strictly monitor or investigate suspected cases of reinfection.
KHN has sent re-infection surveillance inquiries to all 50 states and the District of Columbia. Of 24 responses, less than half provided details on cases of suspected or confirmed reinfection. Where officials said they were actively monitoring for reinfection, they found far more possible cases than previously expected.
In the state of Washington, for example, health officials are investigating nearly 700 cases that meet the criteria for possible reinfection, with three dozen awaiting genetic sequencing and only one case being confirmed.
In Colorado, officials estimate that possible reinfections make up only 0.1% of the positive cases of coronavirus. But with more than 396,000 cases reported, that means nearly 400 people have been infected more than once.
In Minnesota, officials have investigated more than 150 cases of suspected re-infection, but they do not have the genetic material to confirm a diagnosis, a spokesman said.
In Nevada, where the first U.S. case of COVID re-infection was identified last summer, Mark Pandori, director of the state health lab, said there will undoubtedly be cases unmarked.
“I predict we are missing cases of reinfection,” he said. “It’s very difficult to determine, so you need specialized teams to do the work, or a core laboratory.”
Such cases differ from cases of so-called long-distance COVID, in which the original infection causes debilitating symptoms that linger for months and viral particles can be detected. Re-infection occurs when a person is infected with COVID, clears the stem and becomes infected with another strain again, raising concerns about continued immunity to the disease. Such reinfections occur frequently with four other coronaviruses that spread among humans, causing colds.
“Many patients ask, ‘How long do I have to worry about getting COVID again?’ I literally say to them, ‘You’re probably safe for a few weeks, even up to a few months, but otherwise it’s really unclear.’
– Dr. Edgar Sanchez, Physician for Infectious Diseases
Centers for Disease Control and Prevention Guidelines ask to investigate possible re-infection when someone tests positive for COVID at least 90 days after an original infection (or at least 45 days for ‘highly suspicious’ cases). Confirmation of reinfection requires genetic sequencing of paired samples from each episode to determine if the genome involved is different.
But the US does not have the ability to make robust genetic sequencing, the process that identifies the fingerprint of a specific virus so that it can be compared to other strains. Jeff Zients, head of the federal COVID task force, noted late last month that the U.S. is 43rd in the world in terms of genomic sequencing.
To date, only a fraction of the positive coronavirus samples have been followed up, although the Biden administration is rapidly expanding the effort. On February 1, the CDC director, Dr. Rochelle Walensky, told reporters that the order has increased tenfold in the past few weeks, from 251 series the week of January 10 to 2,238 the week of January 24. The agency is working with private companies, states and academic laboratories to push up to 6,000 series per week by mid-February.
The state epidemiologist for communicable diseases in Washington, dr. Scott Lindquist, said officials have prioritized genetic sequencing at the state lab, and plan to start genotyping 5% of all samples genotyped. This will enable officials to work through the nearly 700 possible reinfections, Lindquist said. More importantly, the effort will also help to point to the presence of significant mutated forms of the coronavirus, known as variants, that may affect how easily the virus spreads and perhaps how sick COVID makes humans.
“The two areas, reinfection and variants, could possibly cross paths,” he said. “We wanted to stand in front, not behind.”
The spectrum of reinfections complicates one of the main questions of the COVID threat: How long will natural infection or vaccination keep people immune?
Early studies suggested that immunity would be short-lived, only a few months, while more recent research finds that certain antibodies and memory cells can last longer than eight months in COVID-infected patients.
“We do not really know the marker that will indicate immunity,” said Dr. Jason Goldman, an expert in infectious diseases at the Swedish Medical Center in Seattle. “We do not have the test you can perform to say yes or no. do not say you may be infected. “
Goldman and colleagues confirmed a case of reinfection in a man in Seattle last fall and have since identified six or seven likely cases. “This is a much more general scenario than is acknowledged,” he said.
The possibility of re-infection means that even patients who have had COVID should be vigilant to curb the exposure, said dr. Edgar Sanchez, an infectious disease physician at Orlando Health in Florida, said.
Many patients ask, ‘How long do I have to worry about getting COVID again? ‘, He said. “I’m literally saying to them, ‘You’re probably safe for a few weeks, maybe even up to a few months, but otherwise it’s really unclear. ‘
The message is similar for the wider society, says dr. Bill Messer, an expert in viral genetics at Oregon Health & Science University in Portland, who considered the cultural psychology of the COVID response. Evidence suggests that there will not be a clear return to normal.
“The idea that we will end this pandemic by beating this coronavirus, I do not think, that is actually the way it is going to happen,” he said. “I think we’re more likely to learn how to be comfortable with the new virus that is spreading among us.”
Kaiser Health News (KHN) is a national news service for health policy. This is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.