<p>Second Episode of COVID-19 in Health Professionals: Report of Two Cases</p>

Abstract

Although primary infection has been shown to prevent reinfection of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) in animal models, gaps in the understanding of the immune response to the virus have not been adequately addressed, and some cases of possible reinfection have been reported; however, the frequency, relevance and proof of these events have yet to be determined. We report cases of two doctors who had two episodes of COVID-19 with positive RT-PCR (reverse transcriptase polymerase chain reaction) test results, raising the probability of reinfection. Case 1 was a 40-year-old male physician who presented fever and respiratory symptoms on April 10, with a positive RT-PCR test for SARS-CoV-2, with complete improvement of symptoms in five days. After 44 days, the patient presented the same symptoms of the previous episode, associated with anosmia and dysgeusia. The results of a new RT-PCR test performed two days later were positive for SARS-CoV-2. Case 2 was a 44-year-old female physician who worked in a reference clinic for COVID-19 (coronavirus disease 2019) and had onset of symptoms indicative of the disease on April 30. The RT-PCR test was positive for SARS-CoV-2, with improvement of symptoms in six days. On May 24, the patient presented fever, cough, and sore throat accompanied by headache, asthenia, myalgia, and diarrhea, and in this new episode, anosmia and dysgeusia were also present. A new RT-PCR test from nasopharyngeal swabs was performed with a positive result. Our two patients described here and other patients with possible reinfection who are now being observed in clinical practice reinforce the need to expand the investigation. Then, if the risk of reinfection is confirmed, these findings will be relevant from a clinical-epidemiological perspective to define isolation strategies and develop vaccines.

SARS-CoV-2 Reinfection among Healthcare Workers in Mexico: Case Report and Literature Review

“…In this context, it has been pointed out that extended periods of positive RT-PCR tests in patients could be associated with prolonged viral shedding. Other studies have reported an average time of 34.5 days between the first and second RT-PCR confirmation in possibly reinfected health professionals [ 15 ].…”

“…In the cases of probable reinfection described in the literature, cases of second infection with practically no symptoms have been found, suggesting a response of the immune system according to the previous encounter; and second cases of greater severity, even fatal, have also been shown, suggesting that the immune system was seriously compromised. Therefore, it has been pointed out that the severity of the reinfection depends on the immune response of each individual, as well as on the dose of virus to which they are exposed, the differences between the SARS-CoV-2 variants and the previous health status [ 15 , 36 , 37 ].…”

“…A 24-year-old nurse with no history of pathology, with a 38-day difference between cases and with positive RT-PCR at the onset of symptoms in both cases [ 31 ]. Another report showed 2 cases of physicians in patient care units with COVID-19, with a difference of 46 and 24 days between the first and second case, both clinically and by laboratory discharged, and with negative serology for immunoglobulin G (IgG) and immunoglobulin M (IgM) after the first case, which could mean the absence of neutralizing antibodies, which means that the individual did not have the capacity to prevent a subsequent infection by the same agent [ 15 , 33 ].…”

A Possible COVID-19 Reinfection Case in a Healthcare Professional

“…Recently, SARS-CoV-2 reinfection has been a topic of debate. Suspected reinfection cases were reported among medical professionals who were at an increased risk due to repeated exposure to Covid-19 patients (16). However, it was criticized that these cases could be prolonged viral shedding, relapse or true reinfection (10,11).…”

“…De Brito et al (16) recently reported two doctors working in a reference clinic for COVID-19 with two clinical episodes of COVID-19. The authors concluded that the only way to distinguish these two cases, whether these were reactivations of previous infections or true reinfections was to demonstrate that they were molecularly distinct viruses.…”